WQ0014565_Monitoring - 03-2022_20220420

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DWR - NonDischarge Monitoring Report Submittal •4 ..
NORTH CAROLINA
Erwlranmenlcl QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* wq0014565
Name of Facility:* Pilgrims
Month:* March Year:* 2022
Report Information
Type* Upload Document*
GW-59 March groundwater.pdf 318.7KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Tina Pedley
Signature:
Date of submittal: 4/20/2022
This will be filled in automatically
Initial Review
.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Gerald,Wanda

Is the project number correct?* WQ0014565
Is the monitoring report accepted?* Yes No
Regional Office* Raleigh
Accepted Date: 4/26/2022

GW-59A COMPLIANCE REPORT FORM Permit D01'.{S1p5
(Submit one each monitoring period with G W-59 forms.)
I Enter date monitoring results were due.( 3D-4) Will this monitoring report(GW-59 and GW-59A) YES ' tJ
be submitted after the established due date?
2 Was any required information missing on the G14-59 report forms? YES 6..9)
IF the answer to question i 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,missing YES O
identification plate,arca overgrow n,etc.)?if the answer is ]es contact the Regional Office for guidance.
4 Are any monitored constituents equal to or above the established standards? e NO
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
M .J A-3 - s S S o o Mvt4H pH a Es8 Ntvt) P N 8.0
i
For the constituents identified in question 4 above, have standards been exceeded previously for the NO
same constituent(s)in the same well(s)in the last two years? Alsr oid 'IDS/ pfl A.U.e
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
to.17clards, concentration(s)reported, and sample collection date for each occurrence(for the last two years).
151.21 MW kfpi1 (. 1-) �� '7/SIf, ticw pH S:79 ,� `e
J/I1a( Mw4# ( �N LI,B y� 3/tlzt Mtf ( pH 91S' �tit1° k y�g
tram/so Mw4l t pH 5.35 't rrt4o/20 ,uut 44 tp pit 5.10 '� �t
7 10 M' - I pH (c Q r 3�7� no*
6 Are the monitoring wells listed in section 5 located at or beyond the review boundary? 1 ES
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 le
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 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(Compliance Report GW-59A)is true and complete to the best of my knowledge.
Signature of Permittee(or Au horized Agent) Date
CW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
Ma i l original DEPARTMENT OF ENVIRONMENT th NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to DIVISION OF WATER QUALITY-INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27899-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: W00014565 Expiration Date: 10-31-2025
Facility Name: Pilgrim's Pride Corporation Non-Discharge UIC
Permit Name(if different): NPDES Other
Facility Address 484 Zimmerman Road TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford tSmme NC 27330 County Lee Ll Lagoon ❑Remediation:Infiltration Gallery
€ tr) (Slate) (Zip) ❑■ Spray Field ❑Remediation:
Contact Person: Tina Pedley Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name Processing Plant No.of wells to be sampled: 5 0 Water Source Heat Pump ❑Other:
(from Permit) --... .
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-1 Date sample collected: 03/08/2022 FIELD ANALYSES: WAS
Well Depth 16.6 ft. Well Diameter: 2 En, pH 00400 8.88 units Temp.00010: 13.9 °C DRY at
Mhos time of
Depth to Water Level azsas:5-7 ft.below measuring point Screened Interval: ft. to ft. 5pec. Cond.ixw94 µ sampling,
Measuring Point is ft.above land surface Relative M.P. Elevation: ft. Odor 000es• check
Volume of water pumped/bailed before sampling: 6.00 gallons Appearance here:❑
Samples for metals were collected unfiltered- ❑YES ❑ NO and field acidified: 0 YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 03/08-29r2022 Laboratory Name: Cameron Testing Services Certification No. 654
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD coons mg/L Nitrite(NO2)as N oasis mg/L Pb-Lead o1051 ug/L
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.627 mg/L Zn-Zinc 01092 mg/L
Coliform MF Total 31504 /100mL Phosphorus:Total as P 00665 <0.050 mg/L
(Note Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
lissolved Solids Total 70300 <25 mg/L Al-Aluminum of los mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 <1.00 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 4.00 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1o02 uglL Chromium,Total 01o34 uglL
Grease and Oils 00552 mg/L Cu-Copper 01042 mglL ORGANICS:(by GC,GC/MS,HPLC)
Phenol 32730 ug/L Fe-Iron o104s uglL (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mglL Hg-Mercury 71900 uglL Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 _µMhos K-Potassium 00937 mg/L VOC 78732 ,method#
Total Ammonia 00610 <0.100 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen.Moss N Amrnonia Nrtrogen,Total) Mn-Manganese moss uglL ,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 laboratory analytical data was produced using approved methods of analysis by a
DWO certified laboratory. I am aware that there are significant penallies for submitting false information,including the possibility of fines and imprisonment for knowing violations.
,-i
DA'N t,eL S XN ft J 04 l¢k AkaACtler
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Permittee(or Authorized Agent)Name and Title-Please print or ty0e SIgnature of Permittee •r Authorized Agent) (Gate)
GW-59 Rev 2t2010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: DIVISION OF WATER QUALITY-INFORMATION PROCESSING UNIT y,
and 1 copy to �,-� . ,��,
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 276991617. Phone:[phone]
FACILITY INFORMATION Please+rintClearlyorType PERMIT Number: WQ0014565 Expiration Date: 10-31-2025
Facility Name Pilgrims Pride Corporation Non-Discharge UIC
Permit Name(if different): NPDES Other
Facility Address: 484 Zimmerman Road TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford 's"°"1 NC 27330 County Lee © Lagoon ❑Remediation: Infiltration Gallery
i dyt ;,isle} (Zip>
❑■ Spray Field ❑Remediation:
Contact Person: Tina Pedley Telephone#: [phone] El Rotary Distributor 0 Land Application of Sludge
Well Locat£on/Site Name: Processing Plant No.of wells to be sampled, 5 ❑ Water Source Heat Pump 0 Other:
(from Perrniy
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-2 Date sample collected:. 03/0812022 FIELD ANALYSES: WAS
Well Depth: 33 0 ft; Well Diameter: 2 in. pH o0400 8.01 units Temp.0001o: 16.7 °C DRY at
Depth to Water Level 82546:15.2 ft.below measuring point Screened Interval: ft to ft. Spec-Cond.00094: µMhos time of
sampling,
Measuring Point is ft.above land surface Relative M P. Elevation: ft. Odor woes- check
Volume of water pumped/bailed before sampling: 9.00 gallons Appearance here:❑
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: El YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: 03)8-292022 Laboratory Name: Cameron Testing Services Certification No. 654
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00515 mg/L Pb-Lead 01051 ug/L
Coliform. MF Fecal 31616 <1 /100mL Nitrate(NO3)as N oos2o 0.483 mg/L Zn-Zinc o1092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus Total as P 00665 0.100 mg/L
Mote Use MPN method for highly turbid samples} Orthophosphate 70507 _ mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 66.0 mg/L Al-Aluminum o11o5 mglL
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOCooseo 3.77 mg/L Ca-Calcium 00916 mg/L
Chloride()ow 15.0 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper oi042 mg/L ORGANICS:(by GC,GC/MS,HPLC)
Phenol 32730 ug/L Fe-Iron o1045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate o0945 mg/L Hg-Mercury 71900 ugh Lab Report Attached? 0 Yes(1) ❑ No(0)
Specific Conductance 000es µMhos K-Potassium 00937 mg/t- VOC 78732: ,method#
Total Ammonia oosio <0.100 mg/L Mg-Magnesium 00927 mg/L ,method#
(Arsons Nitrogen:NH3 asN:Ammonia Nitrogen,Total) Mn-Manganese o1055 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: mglL 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.accurate,and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
MVO certifiedlaboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
171As-N ►EL S rr-! t C1(svAila K Mov,a.r 11111 I It- ,2..2
Permittee(or Authorized Agent)Name and Title-Please print or Signature of Permittee(or Authorized Agent) (Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: DIVISION Of WATER QUALITY-IINFORMATION PROCESSING UNIT
and 1 copy to: .� =
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27899 161 Phone:[phone]
FACILITY INFORMATION Please Print Clearty or Type PERMIT Number: W00014565 Expiration Date: 10-31-2025
Facility Name' Pilgrim's Pride Corporation Non-Discharge UIC
Permit Name(if different): NPDES Other
Facility Address: 484 Zimmerman Road TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford fslreeo NC 27330 County Lee _ El Lagoon El Remediation: Infiltration Gallery
(cttyl fare` izr ❑■ Spray Field El Remediation:
Contact Person Tina Pedley Telephone#: [phone] El Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name: Processing Plant No of wells to be sampled' 5 ❑ Water Source Heat Pump El Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-3 Date sample collected: 03/08/2022 FIELD ANALYSES: WAS
Well Depth, 15.7 ft. Well Diameter_ 2 in. pH 00400: 7.17 units Temp.00010: 14.2 °C DRY at
point Screened Interval- ft. to ft. Spec. time of
Depth to Water Level 82546 7.0 ft.below measuring
Cond.00094: µMhos
sampling,
Measuring Point is ft,above land surface Relative M.P.Elevation ft Odor 00085: check
Volume of water pumped/bailed before sampling 4.50 gallons Appearance here:❑
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: 03108-2922 Laboratory Name: Cameron Testing Services Certification No. 654
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 uglL
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.485 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus Total as P owes 0.054 mg/L
(Note: Use MPN method for highly turbid samplesi Orthophosphate 70507 mglL Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 5500 mglL Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug!L
TOC oosso <1.00 mg/L Ca-Calcium oasis mg/L
Chloride 00940 69.5 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 uglL Chromium:Total 01034 uglL
Grease and Oils o0552 mg/L Cu-Copper 01042 mg&L ORGANICS:(by GC,GC/MS,HPLC)
Phenol 32730 uglL Fe-Iron 01045 uglL (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 ao095 }Mhos K-Potassium 00937 mglL VOC 78732 ,method#
Total Ammonia oast° <0.100 mg/L Mg-Magnesium 00927 mglL ,method#
(Ammonia Nitrogen;NH3as N,Ammonia Nitrogen,Total) Mn-Manganese o1055 ug!L ,method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L ,method#
For Remedlation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs, mg/L VOC Removal%
I certify'hat.to the best of my knowledge and belief,the 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
{MO-certified laboratory, I an aware that there are significant penalties for submitting false information,Including the possibility of tines and irnprisonment for knowing violations.
1)4 ll ) 1 EL. c 4 ti.3 C-' i .JC. f \cu o r {.~. - ! k-L.L a. z Z
Permittee(or Authorized Agent)Name end Title-Please print or ty Signature of Petmittee(or Authorized Agent) (Date)
GW-59 Rev 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT 3 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: DIVISION Of WATER QUALITY-IINFORMATION PROCESSING UNIT
and 1 copy to ��- \ ,;,.. :
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 2769a 1617; Phone:[phone]:-
FACILITY INFORMATION Please Print Clearly or type PERMIT Number: WQ0014565 Expiration Date: 10-31-2025
Facility Name: Pilgrim's Pride Corporation Non-Discharge UIC
Permit Name(if different). NPDES Other
Facility Address: 484 Zimmerman Road TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford `Shea" NC 27330 County Lee ❑■ Lagoon ❑Remediation:Infiltration Gallery
(city) (Stele) (yv)
❑■ Spray Field ❑Remediation:
Contact Person: Tina Pedley Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: Processing Plant No.of wells to be sampled 5 ❑ Water Source Heat Pump ❑Other:
(from Pemil)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-4 Date sample collected, 03/08/2022 FIELD ANALYSES: WAS
Well Depth: 17.8 ft. Well Diameter. 2 in. pH 00400: 7.81 units Temp.Doom 12.2 °C DRY at
Depth to Water Level 82546:4.4 ft.below measuring point Screened Interval: ft. to _ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is ft.above land surface Relative M.P. Elevation ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 6.75 gallons Appearance here:❑
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: o3ro8-2912022 Laboratory Name, Cameron Testing Services Certification No. 654
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 o0620 0.073 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 0,050 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 _mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 86.0 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooeeo 1.15 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 38.0 mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total 01034 uglL
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS:(by GC,GC/MS,HPLC)
Phenol 32730 ug!L Fe-Iron 01045 uglL (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 µMhos K-Potassium 00937 mg/L VOC 78732: ,method#
Total Ammonia 00610 <0,100 mg/L Mg-Magnesium 00927 mg/L ,method#
omerrarra Nilrogen;NHsas N,Ammonia Nitrogen.Toter)
Mn-Manganese 01055 uglL ,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%
I certify that to the best of my knovdedge and belief,the 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
OWO certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility at tines and imprisonment for knowing vialations,
1 *.) L Err S IA taw teiM pt X Ca r I .,eet{lc,,� .t a,z
Permittee for Authorized Agent)Name and Title-Please print or type Signature of Permittee(or Authorized Agent) (Date)
GW-59 Rev,2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: DIVISION OF WATER QUALITr4NFOR MATION PROCESSING UNIT ��� ��
and1copyto ,-,_ � �y\.
COMPLIANCE REPORT FORM 1617 MAIL'SERVICE CENTER,RALEIGH,NC 27699161T Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: W00014565 Expiration Date' 10-31-2025
Facility Name: Pilgrim's Pride Corporation Non-Discharge UIC
Permit Name(if different): NPDES Other
Facility Address: 484 Zimmerman Road TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford (strain) NC 27330 County Lee ❑■ Lagoon ❑Remediation: Infiltration Gallery
(city) (State) MP) I] Spray Field ❑Remediation:
Contact Person: Tina Pedley Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: Processing Plant No.of wells to be sampled: 5 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-6 Date sample collected: 03/08/2022 FIELD ANALYSES: WAS
Well Depth: 18.8 ft. Well Diameter. 2 in. pH o040o 8.61 units Temp.00o10 13 9 °C DRY at
time of
Depth to Water Level 62546:9.2 ft.below measuring point Screened Interval: ft. to _ft. Spec.Cond-000s4- ',Mhos
sampling;
Measuring Point is ft.above land surface Relative M,P_.Elevation: ft. Odor 00085 check
Volume of water pumped/bailed before sampling: 5.25 gallons Appearance here.❑
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: -2912022 Laboratory Name Cameron Testing Services Certification No. 654
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01ost ug/L
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.138 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 1100mL Phosphorus:Total as P 00665 <0.050 mg/L
(Note Use MPN method for reply turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
7issolved Solids:Total 70300 114 mg/L Al-Aluminum o11os mg/L
pH(Lab)oo403 units Ba-Barium 01007 ug/L
TOC 00660 2.46 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 27.5 mg/L Cd-Cadmium 01o27 ug!L
Arsenic otooz ugiL Chromium:Total 01034 uglL
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 X.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 _ ug!L Lab Report Attached? ❑ Yes(1) 0 No(0)
Specific Conductance 0009s itMhos K-Potassium 00937 mg/L VOC 78732' .method#
Total Ammonia 00610 <0.100 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen,NMses N Ammonia Nitrogen,Total) Mn-Manganese 010s5 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 laboratory analytical data was produced using approved methods of analysis by a
MO-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations.
D 10, L x ' 1� -' 7 4. Za . z
Permittee(w Authorized Agent)Na e andte Title-Please print oY type Signature of Permittee(or Authorized Agent) (Date)
GW-59 Rev 2/2010