WQ0011360_Monitoring - 03-2022_20220411

GW-59A COMPLIANCE REPORT FORM Permit#A U 0 f P;3 C
(Submit one each monitoring period with GW-59 forms.)
1 Enter date monitoring results were due.( (,k ill this monitoring report(GW-59 and GW-59A) YES Is
be submitted after the established due date.
2 Was any required information missing on the GW-59 report forms? YES lN0
IF the answer to question 1 or 2 is"YES", list in the space provided below the well identification number(s)and �J
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 NO
identification plate,area overgrown,etc.)?If the answer is "Yes", contact the Regional Office for 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 8.
If the answer to question 4 is "YES"list the affected wells individually with constituent(s)and co centra (s)
exceeding standards in the space provided below: rn0_ 5. () (fir ci- c
(�`11N \u` S, EUn S — 1 l
ES
Cc -a T\A E ;a ) k=e_ccA c�6t rsM n Cu\1,100��, 11�- ��;` �D
5 For the constituents identified in question 4 above, have standards been exceeded previo slylfor 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
=stan and , con a tration(s)reported, and sample collection date for each occurrence currence(for the last two ears.
� s-`t--a( s-,t), mu)--a 3 -4-at �.3 (c00-�,.
3- t -aa -5,c 1w-y--ao �a t �3 "k - , c,a kv--4- 0 s'4 . 4
Il-s- aI s 8 i) -C,- ao s, s 1I—s— 16, 3 — E,— ao S% n
'1- r - al S.:\ 3-/c-ao s‘ 11 (A-` - al s,3 3 - /c- an -1`)
6 Are the monitoring wells listed in section 5 locatedlat or beyond the review boundary? YES 1N0�
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 maybe 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 ay be
required to determine the impact the waste disposal system is having at the review and comp - nce "7�
n.
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of: iolatio
fines, and/or penalties. KH :t. z
APR 13 2022 744 , Ti
,n Q ^"mayy
CJ") - IV 1
c7
8 The person completing this portion(GW-59A)of the monitoring report should sign below and st mit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-5S form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report(Compliance Report GIN A)is complete to the best of my knowledge.
L-k•
— Iv!"ram g.,,,,‘
Signature of Pe ittee(or Authorized Agent) Date
GW-59A 12/8/2903

(c,)(4
3 - t - as `1 c_A to er.
- a\ vvs
to
r) - c- 30
3 - 1 - aO l* 3
1
)\-\s_ c•i\Q- r'D\
as (k(\* 3 - l-ate 3-1 (tRtLk -
�� - S- �T , 6 ll- s- al ct3
(1 -- a\ 3 -
- ao 3 -
3 - /G -ao
3 - - 'a ct o
stn
3 - 4- a\ LL-(-
v--*- Q. (3 o
r) - c - ao 5i

•
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail origins I I '' ' i 'f t', + i.'S ' ", i+ i
COMPLIANCE REPORT FORM mid 'I copy to:
FACILITY INFORMATION — Please Print Clearly or Typ PERMIT Number: 001 L � iration Date: a --)
Facility Name: C1c�C Cam\ (eP �
�}��� k'c6\`\ Non-Discharge VV
UIC
Permit Name(if different): NPDES Other
Facility Address:, 1 O r j 'F.\ co, Q ( r
r
` 1 � mac- TYPE OF PERMITTED OPERATION BEING MONITORED
(�r \E.0 ,Nhr..:q A ) \
County loACkE-C1 It}-ragoon ❑ Remediation: Infiltration Gallery
ir++yl 051-i.) 'ipl
Contact Person: (<:.�r,c �)(2S��s .p ,�C, Telephone#7 /n�
} spray Field ❑ Remediation:
jw —��� —`� ��y El Rotary Distributor ❑ Land Application of Sludge
VVell Location/Site Name: .PX 1 .,-`kI - ( I\ No.of wells to be sampled: c,,�j LI Water Source Heat Pump ❑Other:
from Permit -
SAMPLING INFORMATION (� If WELL
WELL ID NUMBER(from Permit): 1`\W"" Date sample collected:3— t t-� FIELD ANALYSES: WAS
Well Depth: 1LA. ft. Well Diameter: in. pH oo4005-, C units Temp. 000io:(J ,i`l°C DRY at
Depth to Water Level 82546: t '%<�, ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.000ser µMhos time of
Measuring Point is �, ' .'- ft. above land surface Relative M.P. Elevation: ft. Odor 00085: c. sampling,
CT �\ S i�� .CJ check
Volume of water pumped/bailed before sampling. ) gallons Appearance 3V C,C`` here:
7-1
Samples for metals were collected unfiltered: II YES ❑ NO and field acidified: Ni YES ❑NO
LABORATORY I[<,,1FORMATI N
Date sample analyzed:, -?,j- 3-313-1 i j -r/1/3-'/u; boratory Name:\ (o C2'.N\�`/'N Certification No. ��
PARAMETERS NOTE:Vai s should reflect distolvediand colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead most ug/L
Coliform: MF Fecal 31616 � /100mL Nitrate(NO3) s N 00620 4
C� ( 3) c �) =,,,, mg/L Zn-Zinc 01 osa mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 `) % k c�,- mg/L
(Note )Jee MPN method for highly turbid samples) 70507 Orthophosphate
nmg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 c› 3
mg/L Al-Aluminum at 105 mg/L
pH(Lab)00403 units Ba-Barium 0.007
uglL
TOC 00680 mg/L Ca-Calcium 00916
mg/L
Chloride o0eao `7''
=` �. `-� mg/L Cd-Cadmium 01027 ug/L
Arsenic c000z ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper oto42 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 moss µMhos K-Potassium 00937 mg/L VOC 7873 method#
Total Ammonia oos10 ,(1mg/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 rng/L NI-Nickel 01067 ug/L method#
For Remedlatlon Systems Only(Attach Lab Reports): mg/L Effluent Total VOCs: e
p Influent Total VOCs: mg/L VOC Removal%
,u rill,/Thal to th, .t:,l of nr, I?1,r h l,_p in,.I h.h,f Ill,:1uf.iin.,t,,n,-.Lit a Hair=1 m Iln + 0411,) , :u,:.n++t ❑u;l t.t oll,lirlt. :,i,I II,,,f ili,:IA ir:-d,dy ni.110,,_.11 +-il,1.st:a +,' r , ...
DIAV-c<rbll,:[I iiihol-llory. 1.Hit:i•,:+n':Ilial Ihurr'Ili ',lyniIlc:unl 1ic.iu,Ilir:,lur suuntlltu+il tul:c:lnluintall,;n,includi . IIi. J;:.: ii ii l i,n+,l ygne,n rl ul l+c l„r,(rn+rd; I. hi:+
J I _iLihfi nl line;an,l Ingnl�>unnti.rd I,n luutriincl irdahou:.
Permittee(or Authoriz:d,gent)Name and Title-Please print or type 1 Cam..
Sign: �re�,•�'i.•ir ee(or Authorized Agent)� (Data)
GW-59 �'ev. 06-07-2018 --

• SUBMIT FORM ON YELLOW PAPER ONLY
Mall original I. III`j I I � �i II If �� i, idt ' r.� fit,,?,.
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM arul 't cr7py icy:
,, r, ..(r r 'I., ," sl ,4I,dju l ..1?"1 ¢.tl r. :` is ,,, `' '.;M,,:.
FACILITY INFORMATION i Please Print Clearly prType PERMIT Number f
,6 d ,},3 (ppiration Date: i) -t,. II-,' ' g t
Facility Name:
��C 1C-'C' 0,11. 4.� ���{"'� Non-Discharge UIC
Permit Name(if different): NPDES Other
Facility Address. L c ()CV TYPE OF PERMITTED OPERATION BEING MONITORED
County c b\CAA(-�-\ [1].-L-ageon Li Remediation: Infiltration Gallery
0.449 i3talo) (tip) rr��--,�
/ z v�Spray Field ❑ Remediation
Contact Person: \<(C� 0 \ "\-Q( "� Telephone#: 4)/a c )J 3 Yd Y ❑ Rotary Distributor ❑ Land Application of Sludge
VVell Location/Site Named )Ac"i(-VC_ o C. b\Y('\ No.of wells to be sampled: v�" - ❑ VVater Source Heat Pump ❑Other:
p_..--..._.r..-.,..»................._.__.w.,....,.....a_.. tromPermr�MA...�..._...,
SAMPLING INFORMATION .,.
*� If WELL
WELL ID NUMBER(from Permit): ��\ "" o Date sample 3 o i,°collected: c�C a
s FIELD ANALYSES: WAS
Well Depth: d�LJL ft. Well Diameter: a, In. pH ooaoo(( r r,\units Temp. 00010:- Pif..i s) °C DRY at
Depth to Water Level 82546: C t 3 ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.Doosa. µMhos time of
MeasuringPoint is sampling,
i ..r, ft.above land surface Relative M.P. Elevation: ft. Odor oeoes: t
C`' lLIY� check
Volume of water pumped/bailed before sampling: --.`;) gallons Appearance Qk c\ here:
Samples for metals were collected unfiltered: is YES ❑ NO and field acidified: IN YES NO
LABORATORY NFORMATION 7 ---
Date sample analyzed: — --'� `3 )—C 3���" Laborator Name: 1`
� t
+ /� , —q Y \A ^fir,, ' _t�� Certification No. 9
PARAMETERS NOTE:Valdes shdLid reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead U1651 ugh.
Coliform: MF Fecal 31616 fl C hi q /100mL Nitrate(NO3)as N 00620 � � 4 3mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 \ /100mL Phosphorus:Total as P 00665 4,H.ri mg/L
(Note' Use MPN method for highly turhid samples)
r Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
7issolved Solids:Total 70300 C.) tS mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007
ug/L
TOC 00680 mg/L Ca-Calcium 00916
mg/L
Chloride 00840 mg/L Cd-Cadmium 01027 ug/L
Arsenic o 1002 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 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 00095 µMhos K-Potassium 00937 mg/L VOC 7873 method#
Total Ammonia omit) 4.. (' , 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 rng/L NI-Nickel 01067 ug/L method#
For Remedlatlon Systems Only(Attach Lab Reports): Influent Total VOCs:
mg/L Effluent Total VOCs mg/L VOC Removal%
I cerlify 11101 In iiiii Ili:,t of nil I II(nit drl "nnJ'Rik f flit;nit tin‘,hr ii+cufnnili.d in(hi ii I,riiI is hilt. ,1,,.ni II,: 'nid c ntl,lr.It. :III I 1l1:it Ilia I,d il:alor ii tlyiic:i I i if i ,a:c l in hir.erl u;m I vim wr d Inshr.!: rJ.1r1,i1lsdo-.ly,1
MAID cerliIi iibal,nl_llory l;.un unit.tli d Ihel IOU snyni0ce11l tit.1,1111 i tt,r sul:rimlluig f,11,,-infonn:nlion,Irn-ltuli111 Ilic.I j.,iltdny of fu,,:,and['dpniunlnr:nt for luu,vviny viol:ihon.
Altinifigg'
C _ re 'I�'Ao►ed q - I_ go?,
Permittee(or Apthoriz:d Agent)Name and Title-Please print or type Sign., /re�p�-r.•it ee(or Authorized Ayenq
(L)ate)
GW-59 Rev.D6-07-2018

I
• SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING, Mail original I "it' i; i' 1 , r I. 'a I �-
I ,t1 �� 1 hri;
COMPLIANCE REPORT FORM and 1 copy to:
t 3tsp {sr irl s,.xi ,at1 ti k .,i t.1,.:w, nt. '.,,1 p P,tv(. f+- .der :;l,r}'1:.,,,,
FACILITY INFORMATION. Please Pont clearly or Type PERMIT Number Q xptration Date: (� t)
Facility Name: kCk( F(?t -�ft(\l�CZ�( O-,(� Non-Discharge � 0 UIC
Permit Name(if different): NPDES Other
Facility'A`ddcess: 1 v ,� �j ( N�_, \\�`�� �C\Ci� TYPE OF PERMITTED OPERATION BEING MONITORED
\c--kc V V rC.,_ �:�I nliq (�
C ` �j� (�, j County .�VAe� P-Cagoon Li Remediation: Infiltration Gallery
wily) iatat.l alp)
{� F pray Field IDRemediation:
Contact Person: \K\M'k\c QfJ4j Telephone#:A�v"'ar6`"33�' ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: a r'., tke �Ll ' i iN L�a Od No.of wells to be sampled: C ❑ Water Source Heat Pump ❑ Other.
SAMPLING INFORMATION (�',\ If WELL
WELL ID NUMBER(from Permit): '\`\W-•.,.t Date sample collected:3`•` — c}ti FIELD ANALYSES: WAS
VVell Depth: 14- ft. Well Diameter: � in. pH oo4oa } Temp. I ly ; DRY at
jf units o0010:Iti ( 0C
Depth to Water Level 8254s: 1----' ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.mesa' 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: gallons Appearance - C-4 ")C 0\k1('"\ here:
Samples for metals were collected unfiltered: $YES ❑ NO and field acidified: ®YES ❑NO \\
LABORATORY INFORMATION
Date sample analyzed:3-- I , 3 •(f 1.*313 ,3-•C/,3"/d� ratory Name: G'\ \ (O '(?.(`'(\ Certification No. Ci -
PARAMETERS NOTE:Va es sh uld reflect dfssolvell and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 uglL.
Coliform: MF Fecal 31616 /100mL Nitrate(NO3) s N men g
C�,J t r ( a) (� � ,�`�` mg/L Zn-Zinc a lost m /L
Coliform: IVMF Total 31504 /100mL Phosphorus:Total as P 00665 k , \ Y mg/L
(Note. Use MPN method for highly lurhld samples)
/� Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
d �Ci
dissolved Solids:Total 70300 b mg/L AI-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC oosao mg/L Ca-Calcium 00918 mg/L
Chloride 00940 ‘' \ mg/L Cd-Cadmium 01027 ug/L
Arsenic o1o02 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/L ORGANICS: (by GC, GC/NIS, 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 00095 µMhos K-Potassium 00937 mg/L VOC 7873 method#
Total Ammonia ooslo 1 mg/L Mg-Magnesium 00927 mg/L method#
(Ammonia Nitrogen,NHs es 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: e g mg/L VOC Removal%
I ceriiiy Ihi,l la th,I r:d of my'I u .:I,-,I;jr and(n itsf (ha infannali,m=:ulmult,>-I in Ihr i.l,;;r1 r.;tin:.au in ih. Iti,l r:,nil 1,:ie :mil that th, I,t aaluf,, a 1),h-ail I lid::'a< r ,, ,_I i hii.rl u.ui i nj�gnu�rriin,ahr.l. nfhnal/r.ir.Ly.�DWf�-cnrli(ic.d lahc te)1,1y. Hot,r..,n th.d(hot'rtic ntt ilicnnl po inI(n 5 ir;r'arlimilluig Inl iidcnmah in,innIlidlI j II,palst nluo nitill :Ind iinpoi snntneili lot Itnon n n g ot,llions- k RI RION _ --
Permittee(or Authorized Agent)Name and Title-Please print or type Sign. ire. •-r.•It ee(or Authorized Agent)
(Date)
GW-59 Rev.D6-07-2D18

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original I; ,. :,r I i t,S I ,!' ) 1 .,'I,' d f n ,r , , .. I i 45
GROUNDWATER QUALITY MONITORING: ry..
COMPLIANCE REPORT FORM anti 'I copy to:
Gp. ;, N'� �e �: a, 1a #,�. Ali t ,,:(; wt.kL<<•. tl',n 1'
FACILITY INFORMATION Please Print Clearly or Type f
�} • 1 C.", t 1 PERMIT Number lit 06 3cExpiration Date: 1 —3 I'—c Q
Facility Name: 1 C\C-1\C- .�� �.70%0t\l�crt Co() Non-Discharge UIC
Permit Name(if different): NPDES Other
FacilityAddress: D 3 Yf'.<-1 C e �c‘� �d .�, TYPE OF PERMITTED OPERATION BEING MONITORED
`` IV r p� County Blc+(4Q. (goon ❑ Remediation: Infiltration Galleryo Y 1 ; Ial�j ,_;I,)
It4C�I Z - pray Field ❑ Remediation:
Contact Person: CL�a �\ � Telephone#: I LI5 'C.- 1i '"J�c$ ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: •
DQ. 1GV�b it 0� No.of wells to be sampled: o.-E ❑ VVater Source Heat Pump ❑Other:
.. .. (from Psr-mi�.._..........__.�.....,
SAMPLING INFORMATION ___._.� _.,._._. ......._�... .n.......__... ...._,..,._..... ......... ... .....
If WELL
WELL ID NUMBER(from Permit): c\kU""'.,j Date sample collected:'-1 .„r FIELD ANALYSES: WAS
VVell Depth- 3 ft. Well Diameter: c . in. pH ooaoo.,5 units Temp. 000lo., t3°C DRY at
Depth to Water Level 52546: i Q ft.below measuring point •Screened Interval: ft, to ft. Spec.Cond.00094 µMhos time of
Measuring Point Is '� v c,' ft.above land surface r._ Relative M.P. Elevation: ft. Odor 00085 --1\ 'c&...J sampling,
check
Volume of water pumped/balled before sampling: .� gallons Appearance `kk c • +,r,� t),1 here:
Samples for metals were collected unfiltered: ®YES ❑ NO and field acidified: IN YES LI NO
LABORATORY INFORMATION
Date sample analyzed:,—I`; — 13 3)3-"u�3-7 3 IO aboratory Name: C_5•\\J l 6(�\ _,e-.CV Certification No.
PARAMETERS NOTE:Values should reflect d ssoly and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616 .�' g
--� � C; � /100mL Nitrate(NO3)as N 00620 3 $ t!�, mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 3.150a /100mL Phosphorus:Total as P 00665 t ` ? mg/L
•
(Note. Use MPN method for highly turbid samples) Orthophosphate 70507
mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 ` ; c mg/L Al Aluminum oii05 mg/L
pH(Lab)00403 units Ba-Barium 0.1007 ug/L
TOC 00680 mg/L Ca-Calcium 0o9•Ie mg/L
Chloride 00940 ni mg/L Cd-Cadmium 01027 ug/L
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 ug1L 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('I) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia Dodo 01 ', mg/L Mg-Magnesium 00927
(Ammonia Nitrogen,NH,asN;Ammonia Nitrogen,Total)' mg/L ,method#
Mn-Manganese oioss ug/L , method#
TKN as N 00625 rng/L NI-Nickel 01067
ug1L , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs:
mg/L VOC Removal%i certify th,il to.Ihr,1=:;1 of my I,niiv,lorbp ,Iml ii,llr:f.the infcgin„fion-uhnullr,l w hi I1,',I!i:,Inc, a it I,ii III: rillr I i-:i h/I Ir;.nn.l ili,i il,, I ii rrdLI - _..
.dylic d it III 010 Im,Jnccrl u,in;l:1;pI, rrl m he l d °.c.I y n
PV1qR-pi.lhfircliahui-ll[,iy. I❑nI f.ean fli.d tharu oft:cigi;i(icanl lu:nr,luo-.,Iw sul.rmilluiit Lih,i;irdimna(iou,in�liulinq Hit milli!)p�a ul(Ines aln, nnhu�-;onnicid(oi hnurnni;nolilior;• .
Permittee(or Authorize gent)Name and Title-Please printo Sign lype re �te ' q '-' a
tre� r••it ee(or Authorized Agent) (Data] __
GW-55 .06-07-2018

,
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mrlil of l�linal l i'' I' i °jf I i,In �• ;;. ��'
COMPLIANCE REPORT FORM and 'I copy to: • • tit
FACILITY INFORMATION 1 Please� Print pearl(or Type
PERMIT Number expiration Date: / OR,-
Facility Name: LCkC\\-' \ Qh\A.c\ \ .
k13r\ Non-Discharge UIC
Permit Name(if different): NPDES
Facility Address:` 1 U ra 3 ° ,C�, 1 Q, �, ‘ C4 Other
c. �, ��
iC Y10E� ` ''11e'`„ c TYPE OF PERMITTED OPERATION BEING MONITORED
"Si \ (SW.)
..N County `, \C\ �> goon ❑ Remediation: Infiltration Gallery
_ � 3p1ay Field ❑Rernediation
Contact Person: - ,( Q --k( (0" _ Telephone#qt�'p �� ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:` Cj4R G`�i,ut-� -_�r~ No.o f
lwells to be sam pled: ❑ VVater Source Heat Pump ❑Other.
- - (from Permit)
SAMPLING INFORMATION 11�\\ .,...,. _ ........., ...,._... ....... .. .. .........._.........-.._._.. _
WELL ID NUMBER(from Per it); `�if�iC. If WELL
y Date sample collected: 3' ' r7q. FIELD ANALYSES: WAS
VVell Depth: - ft. Well Diameter: , in. pH 00400: 0 units Temp. 000ioa i S °C DRY at
Depth to Water Level 8254s:
t ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.00094. µMhos time of
Measuring Point is y\� ft.above land surface Relative M.P. Elevation: ft. Odor 00085 j/ sampling,
Volume of water pumped/bailed before sampling: �Q.)„ here:
p g� � gallons Appearance (3 CC�(\��.., here: I
Samples for metals were collected unfiltered: $YES ❑ NO and field acidified: ®YES ❑NO
LABORATORY INFORMATION 1 _
Date sample analyzed3--U ) 3)3--Y' 3 ) —I O"aLaboratory Name: r1\v, t.6C\V- C'
PARAMETERS NOTE:VAIues should FeflectidissoKied and colloidal concentrations. Certification No.
COD 00335 mg/L Nitrite(NO2)as N 00615
mg/L Pb-Lead 01051 uglL
Coliform: MF Fecal 31s1s K 1 L61 /100mL Nitrate(NO3)as N oos2o
�4-- mg/L Zn-Zinc 0-1092 mg/L
Coliform: IV1F Total 3'1504 /100mL Phosphorus:Total as P 00665
(Note: Use MPN method for highly turbid samples) N v C� mg/L
C� Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units)
Dissolved Solids:Total 70300 ( mg/L Al-Aluminum 01105
pH(Lab)00403 mg/L
units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 w mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total oloaa 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
Sulfate 00945 ug/L (Specify test and method#.ATTACH LAB REPORT.)
mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes('I) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium o0937
7 mg/L VOC 7873 method#
Total Ammonia oriels '''''',---,,IC) I mg/L Mg-Magnesium 00927
(Ammonia Nitrogen,NH3as N,Ammonia Nitrogen,Total) mg/L method#
Mn-Manganese 01055 ug/L method#
TKN as N 00625 rng/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%
Orfilly Ih,I to the I :,I c,(nry nn lr:cl,lc ,mrl h,li',f Ihe infomnn i c,,n•;ulmilli,l rr,Il,, 'p"ri it:ilia: .1 n.d, and ci,,yil,°ie Ali I Ilia(ilr I,l ,rr tr,lA/P-r-erh)li=cl la.boi.ii"v I and aware;ILA lhute gm':ignilicanl ,nu_itic;r to i, air,,rn,i in d :r,u;In,rhrorl urdnr of Inc„t rl in,ahr I. .d nnaly•,i, by n NW
sulnulln,7 r ils�;infunn8tmn,Inr_lilrinty Ilr p�ssiLll I of fines antiinpliannlerd la,I;nu�iinUuchhonfit. \C . i , / r
Permittee(•r Aut'•rized Agent) ame and Title-Please print or type � " �%' _ _ "� 1 ,Q
Sign: trey/pr-_'i.•il ee(or Authorized Agent) (Date)
GW-59 Rev.06-07-2018