WQ0037555_Groundwater Monitoring Report (GW59) November 2019_20191231

GW-59A COMPLIANCE REPORT FORM Permit # WQ 03-75j,V�
(Snbtnit one each monitoring period with Gfl'-59 fornes.)
I
Enter date monitoring results were due. ( ) Will this monitoring report (GIN-59 and GW-59A)
YES
NO
be submitted after the established due date
2
Was any required information missing on the GW-59 report forms?
YES
IF 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, missing
YES
NO
identification plate, area overgrown, etc.)? Ifthe 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 B.
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..
�..
...
JAN 0 3 2020
5
For the constituents identified in question 4 above, have standards been exceeded previously.lor the
YES
NO
same constituent(s) in the same well(s) in the last two years?
L.'- _..
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 maybe 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 Region/ Office within 90 days: an evaluation may be
reouired 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.
v'
ni
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit t
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) i true and complete to the best of my knowledge.
Signature of Permittee (or Authorized Agent) Date
GW-59.A 12/8/2003

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