HomeMy WebLinkAboutWQ0007144_Monitoring - 03-2023_20230417 (2)Monitoring Report Submittal
.....................................................
Permit Number#* WQ0007144
Name of Facility:* Camp Seafarer
Month: * March
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
G W-59
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2023
Upload Document*
NDMR , NDAR-1 Reports March 2023.pdf 772.14KB
PDF Only
GW-59 March 2023 Reports.pdf 432.89KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
stan.eudy@seagull-seafarer.org
Stanley Eudy
CStarl�%6 5;1 W%
4/17/2023
This will be filled in automatically
Reviewer: Wanda.Gerald
Is the project number correct?* WQ0007144
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 4/17/2023
SUBMIT FORM ON YFI I OW PAPPR nNf v
GROUNDWATER QUALITY MONITORING:
•�
DEPARTMENT OP ENVIRONMENTAL RUALITY= DlV OF.11UA7ER RESOURcEs
COMPLIANCE REPORT FORM
�,
EN,E,pRr!€ATION pRpCESSING UNIT+
1,617 MML SERVICE CENTER, MLEIGH„NC 27699,1697' Phone 919,807 6306
FACILITY INFORMATION - PleasePrfntCleailyorType
PERMIT" Number: Expiration Date: 7 77 T
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 UIC
NPDES ... Other
Permit Name (if different): YMCA of the Triangle Area, INC.
Facility Address: 2744 Seafarer Rd Arapahoe NC
28510
TYPE
OF PERMITTED OPERATION BEING MONITORED
Lagoon ❑ Remediation: Infiltration Gallery
2744 Seafarer Rd Arapahoe (sime) C 28510 CountyPamlico
(c,tv7 �s,�te) cziar
❑ Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: 252-249-1212
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Lagoon
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Well 2
hate sample collected: _j i `o 3
FIELD ANALYSES:
WAS
Wall Depth: 20 " ft,
Well Diameter: 2 in.
pH 00400:-_5_,Sbunits Temp, 000lo: °C
DRY at
Depth to Water Level 62546: 3 ,13 ft. below measuring point
�_ 9 p
Screened Interval: 10 ft. to
20 fit.
p Mhos
Sec. Cond. 0ao9a: -z g �`
time of
Measuring Point is 1.9 ft. above land surface
Relative M.P. Elevation: 24.2 ft.
Odor o0085: ���%��
sampling,
check
Volume of water pumped/bailed before sampling: -- DR,r
gallons
Appearance CLZ,�J�
here:❑
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION 31 j6� 3 Date
sample analyzed:
Laboratory Name: •
Certification No.
_
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead =51 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NC3) as N 00620 a-, i 7
mg/L
Zn - Zinc 01o92 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P oose5 ®'. O <3
mg/L
(Note: Use MPNmeu,adfor highly tUt;asamPlas)
Orthophosphate79507
mg/L
Other (Specify Compounds and Concentration Units):
Dissolved Solids:7otal70300 3YO mg/L
Al -Aluminum oi.to5
mg/L
pH (Lab) 00403 `7: G units
Be - Barium o1o07
ug/L
TOC 00680 mg/L
Ca - Calcium oogle
mg/L
Chloride 00940 _ _ --mg/L
Cd - Cadmium oho27
ug/L
Arsenic o1oo2 uglL
Chromium: Total 01034
ug/L
Grease and Oils ooss2 mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 3273o 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 00065 tLmhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia ooslc O. mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Wrogen; NH3 as N; Ammonia Nitragen, Total)
Mn -Manganese 01o5s
uglL
,method
TKN as N 00625 mg/L
Ni -• Nickel 01087
ug/L
method #
FU[ r%etiteUjULl0r1aysiems unly tAuacn Lao Keports):
Mike Askew, Director of Facilities and Boating Operations
Permittee (or ALthorized Agent) Name and Title - Please print or type
GW-58 Rev.05-02-2017
lntluent Total vOCs:
mg/L Effluent Total VOCs:
mg/L
VOC Removal%
SUBMIT FORM ON YELLOW PAPER ONLY
DEPAI2TMEN7 0F':ENVIRONMlEENTAL:QUAI-iTY,m DIV.' OF'.WA!'EIR RE50U.RCES.
GROUNDWATER QUALITY MONITORING:
INFORMATION P.ROcEssING UNIT
COMPLIANCE REPORT FORM
1617;MAmSERVICE CENTER, RALEIGPf NC 97699 1617 Phone $19-807 6306
FACILITY INFORMATION Please PrfntClea.dyorType
PERMIT Number: Expiration Date:, %
Facility Name. Camp Seafarer
Non -Discharge WQ0007144 UIC
Permit Name (If different): YMCA of the Triange Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe t&reeS) NC 28510
County Pamlico
❑.La oon ❑Remediation: Infiltration Gallery
g
(City) (Mato) (zip)
K Spray Field ❑Remediation:
Contact Person: Mike Askew
Telephone#: 252-249-1212
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Spray Field 3
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING 114FORMATION
/
If WELL
WELL ID NUMBER (from Permit): WELL 5
Date sample collected: i6 l
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400:1 units Temp. ocolo: �G. bC
DRY at
Depth to Water Level a2546:�^ft. below measuring point
Screened Interval: 10 ft, to 20
—
ft. Spec. Cond. 000sa: --0 µMhos
--
time
i
sampling,
Measuring Point is 2.2 fL above land surface
Relative M.P. Elevation: 27.7 ft.
Odor 000a5: iNG/ "
check
Velume of water pumpedlbailed before sampling: �� C�� Lgallons
Appearance
here:[]Samples
for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
3 1C 2j
Date sample analyzed:
Laboratory Name: Enyiroment 1,1NC.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and dolloidal concentrations.
COD 0o335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead o1o51 ug1L
Coliform: MF Fecal 31616 < /100ml-
Nitrate (NO3) as N 00620 <C) , G
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00565 (3. a �}
mg/L
(Note: Use MPN methbdfor highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al -Aluminum o11o5
mg/L
pH (Lab) 00403 ^ , units
Ba - Barium 01007
uglL
TOC omac mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 mg/L
Cd - Cadmium o1o27.
ugfL
Arsenic olo02 uglL
Chromium: Total 01034
ugfL
Grease and Oils oo552 mg/L
Cu - Copper 01042
mg1L ORGANICS: (by GC, GCIMS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ugfL (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00a4,5 mg1L
Hg - Mercury 71900
ug1L Lab Report Attached? ❑ Yes (1) -- ❑- No (0)
Specific Conductance oeo95 [:Mhos
K - Potassium 00937
mg/L
VOC 7673 method # -
Total Ammonia ooslo C3. mglL
Mg - Magnesium 00927
mg/L
method #
(Ammonla Nitrogen, NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L method #
TKN as N 00625 mg/L
Ni _Nickel 01os7
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg1L Effluent Total VOCs: mglL - VOC Removal%
Mike AskewiDirector of Facilities and. Boating.Operations
Permittee (or Authorized Agent) Name and T-dle - Please print or type
Signature of Permittee (or Authorized Agent)
GW-59 Rev.05-02-2017
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
T . • •
DEPARTMENT:.OF ENVIRONMENTAL QUALITY DIV::OF WATER RESOURCES
INFORMATION PROCESSING. UNIT
COMPLIANCE REPORT FORM
1617'MAr_ SERVICE CENTER, RALEIGH,"NC 27699-1617 Phone: 939-807-6306
FACILITY INFORMATION. PfeasePrintCreariyor7ype
PERMIT Number: Expiration Date: 3 2
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NO 28510
"TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (stree) NC 28510
County Pamlico
El Lagoon ❑ Remedia#ion: Infiltration Gallery
(city) (stela) (zip)
Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: 252-249-1212
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Spray Field 3
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other.
(tram Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from -Permit): Well 6
Date sample collected: 3 1C()-3
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH o0400:�I- ,y, units Temp. 00010: l'Z' -3 oC
DRY at
Depth to Water Level 62545: , Ti> ft. below measuring point Screened Interval: 10 ft: to
20
ft. Spec. Cond. 00094: G > pMhos
time of
Measurin Point is 2.75 ft. above land surface
g
Relative M.P_ Elevation: 20.2 ft.
0 A„ _
Odor 000ss: ,�' L�
sampling,
check
Volume of water pumped/bailed before sampling: / 0
gallons
Appearance C46 _ 1)
here -
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION 3 i� 6
Date sample analyzed: l
Laboratory Name: Enviroment 1,INC.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD oc335 mg1L
Nitrite (NO2) as N oce15
mg/L Pb - Lead o1051 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00e20f G, 6 —
mg/L Zn - Zinc o1092 mg/L
Coliform: MF Total 315D4 /100mL
Phosphorus: Total as P cros5 0,
mg/L
(Note; Use MPN method for highly turbid samples)
140
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total70300 mg/L
AI - Aluminum 011o5
mg/L
PH (Lab) 00403 units
Sa - Barium oloo7
ug/L
TOC 00680 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 7 mg/L
Cd - Cadmium olo27
ug/L
Arsenic oiom ug/L
Chromium: Total 01034
uglL
Grease and Oils o0552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC1MS, HPLC)
Phenol 32730 uglL
Fe - Iron D1045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 7190C
uglL Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 lXhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia oo610 mg/L
Mg - Magnesium oo927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o5s
ug/L method #
TKN as N 00625 mg/L
i
Ni - Nickel oloe7
ug/L method #
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs: mg/L
Effluent Total V00s: mg/L VOC Removal%
Mike Askew, Director of Facilities and Boating Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.05-02-2017
Of
,�6-!3 -23
(Date)
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
DEPARTMENT OF ENVIRONMENTAL QUALITY pIV OF WATER R =SOURCES
INFORMATION PROCESSING UNIT
1617 MAEL SERVICE CENTER, RACLIGH, NC 27699 1617 Phone 919, 807 6306
FACILITY INFORMATION Please Print Claarfy or Type
PERMIT Number: Expiration Date:,
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 UIC
Permit Name (if different): YMCA OF THE Triangle Area, INC.
NPDES Other
Facility Address: 274-A Seafarer Rd Arapahoe NC
28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (street; NC 28510
Coun ty PamliCo
❑ Lagoon ❑Remediation: infiltration Gallery
tc;tyl (stale) tziP)
® Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: 252 249-1212
❑ Rotary Distributor ❑ Land Application of Sludge
Well LocationlSite Name: Spray Field 2
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other.,
{from Permit)
SAMPLING INFORMATION
3116 3
If WELL
WELL ID NUMBER {from Permit): WELL 7
Date sample collected: 1
FIELD ANALYSES: WAS
Well Depth: 12 ft.
Well diameter: 2 in.
pH 00400:Z units Temp. coolo: /_�' °C DRY at
Depth to Water Level 82546:ft. below measuring point
Screened Interval: 2 ft. to
12 ft.
Spec. Coed. 000sa: • % µMhos time Of
sampling
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 25.B ft_
Odor000a5:y"C check
Volume of water pumped/bailed before sampling: DAr
gallons
Appearance C L hare:❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO. and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
3!
Date sample analyzed: /G
Laboratory Name: Enviroment 1,1NC.
Certification No.
PARAMETERS NOTE: Values should teflect dissolved and colloidal concentrations.
COD 0033.5 mg/L
Nitrite (NO,) as N ocei5
mg1L
Pb - Lead oio5i ug/L
Coliform: MF Fecal 31616 < ] 11 OOmL
1
Nitrate (NO3) as N C0620 < Q, D 4.
mg1L
Zn - ZlnC 01092 mg/L
Collform: MF Total 31504 1100mL Phosphorus:
Total as P oases [y , L
mglL
(Note: Use MPN method for highly turbid samples)
OrthophOSphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 b mg/L
Al -Aluminum ciio5
mg/L
pH (Lab) 00403 5; units
Ba - Barium 01007
ug/L
TOC oosso mg/L
Ca - Calcium oo9is
mg/L
Chloride 00940 g mglL
Cd - Cadmium a1o27
ug/L
Arsenic 01002 uglL
Chromium: Total 01034
uglL
Grease and Oils oo552 mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 327aa ug/L
Fe - Iron 01045
ug1L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L'
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pacific Conductance 00095 �LMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia oosio G• 3 mg/L
Mg - Magnesium oo927
mg/L,
method #
(Ammonia Nitrogen; NH,as N; Ammonia Nitrogen, Total)
Mn - Manganese o1055
ug1L
, method #
TKN as N 00628 mg/L
Ni - Nickel 01067
ug1L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
Mike Askew, director of Facilities and Boating Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.05-o2-2017
rng/L
Effluent Total VOCs:
Signature of Permittee
mg/L VOC Removal%
Rt IRMIT FnRM ON YFI I OW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM'
F8911_ITY INFORMATION Pie
Facility Name:. Camp Seafarer
Permit Name (if different): YMCA of the Triangle
Facifty Address: 2744 Seafarer Rd
Contact Person: Mike Askew
Well Location/Site Name: Spray Field 2
Area, INC.
NU ZtSS"I U
or Type
County Pamlico
Telephone* 252-249-1111
No. of wells to be sampled., 5
)EPARTMENT of ENVIRONMENT & NATURAL RESOURCES
AVISION OF. WATER QUALITY4NFORMATION PROCESSING UM7
1617,MAILS ERVICE CENTER,.RAL'EIGH, NC 27699-1617- Phone:=.(919),733422'1: '
PERMIT Number: Expiration Date: uu-SS-' -3737 7
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
® Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
SA G D O
WELL ID NUMBER (from Permit): Wei(S
Well Depth: 12 ft,
Depth to Water Level: 6. ft. below measuring point
Measuring Point is 1 ft, above land surface
Volume of water pumped/bailed before sampling: 3 _ PfP -f
Samples for metals were collected unfiltered: ❑YES
�J f
Date sample collected: �! � �
Well Diameter. 2 in.
Screened Interval: 2 ft. to 12 ft.
Relative M.P. Elevation: 15.3 ft.
gallons
❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES: f C
pH CS, 79 units r Temp. j " �C
Spec. Cond. ! b . µMhos
Odor ly��y
Appearance
if WELL
WAS
DRE of
sampling,
check
here: ❑
LABORATORY INFORMATION 3
Date sample analyzed: 16'.13
Laboratory Name: Environment 1, Inc.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/1
Pb - Lead mg/I
Coliform: MF Fecal C t 1100m1
Nitrate (NO3) as N Ci .
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P _ ar C,
mgll
(Note: Use MPNmethod tor highly turbid Samples)
Orthophosphate
mg/I
Other (Specify Compounds and Conoentration Units):
Dissolved Solids: Total mg/I
Al -Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/1
Ca - Calcium
mg/I
ry
Chloride j ?5 mg/l
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg11
Grease and Oils mgll
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mgll
Fe - Iron
mgll
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mgll
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K- Potassium
mgll
VOC method #
Total Ammonia G mg/I
Mg - Magnesium
mg/I
method #
{Ammonia Nitrogen; NH�as N: Ammonia Nitrogen, Total}
Mn -Manganese-
mgll
method #
TKN as N mgll
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports)
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev, 1/2007
Influent Total VOCs: mg/L
Signature of
Effl uent Total VOCs:
(or Authorized Agent)
mgrL
vuc Kemova)'ro
GW-59A COMPLIANCE REPORT FORM Permit #W q Uo0
(Submit ane each monitoring. period with Gll'-59 foams.)
Enter date monitoring results were duo. ( ) Will this monitoring report (GW-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
N
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.)? If the answer is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
NO
If the answer to question 4 is "NO" skip to section &.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the spaco provided below. /
ev �6
wet(
5 -
For the constituents identified in question,4 above, have standards been.exeeeded_previously for the ..
E4 8
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
standards, concontration(s) reporte , and sample collection date for each occurrence (for the last two years).
5 L,01-- fil uja1., 3f zx , 1)-/2-.?-
►��z� t,o�-- ?d Id a..), 3 Utz fJ, a- 7 s:4 a t
6
Are the monitoring wells listed in ection 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
N
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 facili# . Failure to do so ma subject the permittee to a Notice of Violation
fines, and/or penalties.
RErCIIIIo La"- Nit P-' Mo�/i'"G t111-1LL-.-r
c 3 P
g
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.
l hereby acknow[edge that the above information was evaluated and the information submitted in this
report (Compliance Rep.gFt GW-59A) is true and corrmplpte to the best of my knowledge.
o- `J' /3' ')
Signature of Permittee (or Authorized Agent) Hate
f
/
GW-s9A 12/812003