NC0001970_GW-59A Compliance Report Form_20230515

- . _
SUBMIT FORM ON YELLOW PAPER ONLY
Mai{ Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES" 1
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
RALEIGH,NC 27699-1636 Phone:[phone]
FACILITY INFORMATION �/ Please Print Clearly or Type
Facility Name: jr`Ai
V i / t / PERMIT#: (�' 01> /2 v EXPIRATION DATES ,•1 j 3i 2n/4
Permit Name (if different): Non Discharge UIC
Facility Addr s: 1511 N Ffi,. '9.J i� NPDES Pit L' �' % 7°
(Skeet)
'� � tskre. �✓(.. .-x6'1' County /,7 / TYPE OF PERMITTED OPERATION BEING MONITORED
Contact Person: /-- -"'`'✓'i.✓ > '` /`- -9. Telephone#:C 92°j,_21/-2- 1/.1 / Lagoon Remediation: Infiltration Gallery
Well Location/Site Name: ���;y� 1 No. of Wells to be Sampled: Spray Field Remediation:
1 (from°eT Ht Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): -4 / For Groundwater Treatment Systems Other.
Well Depth: ,2`> ft. Well Diameter: - in. Check one: ❑ Influent (98)
Screened Interval: '`/ ft. to y" ft. El Values should reflect dissolved and . P 1 ltr�y
Depth to Water Level: Il '4. ft. below measuring point. Effluent (99) NOTE; colloidal concentrations. ���u ..
Measuring Point(M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.. MAY 1 0 2023
Gallons of water pumped/bailed before sampling: r� Date sample collected: 3 d) -13 Date sample analyzed: 3 _a 3
Field analysis: pH -r$/ , Specific Conductance uMhos Laboratory Name: �N✓//1,"� Cri'
Temp. // e °C, Odor Appearance Certification No. M'- C'y tworotiarrnPrc.ockwx3tAf
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified V YES NO)
COD mg/ Nitrite (NO2) as N .40.0.2. mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m Nitrate (NO3) as N E.ac' mg/ Pb - Lead mg/I
Coliform: MF Total /100m Phosphorus: Total as P mg/ Zn -Zinc mg/I
(Note:Use MPN method for highly turbid samples) Orthophosphate 0.iv mg/ Ammonia Nitrogen <d.. mg/1
Dissolved Solids: Total 2..) mg/ Al - Aluminum 3,0/, mg/ Other (Specify Compounds and Concentration Units)
pH (when analyzed) units Ba - Barium mg/
TOC 0,7 mg/ Ca - Calcium mg/ s`',`L'Yr` S'.6 cl/
Chloride ic9. mg/ Cd - Cadmium mg/
Arsenic mg/ Chromium: Total mg/ /V,tnar'. -t 14-t721-t6 ! . ��/1
Grease and Oils mg/ Cu - Copper mg/
Phenol mg/ Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate '��
Specific Conductance mg/ Hg - Mercury mg/ (Specify test and method It. Attach lab report.)
p uMhos K- Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/ Mg - Magnesium mg/ VOC : method #=
TKN as N mg/ Mn - Manganese mg/ : method #=
: method #=
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 North Carolina DWO(formerly DEM)certified laboratory.I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations. ---,-
1 V-f
Permittee( th rized Agent)Name and Title-Please print or type
GW-59 ----71 `^- 511 I /
Rev. 03/2000 signatufp I re(or Aut oozed Agent) (Date)

4
SUBMIT FORM ON YELLOW PAPER ONLY
Mail Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES"-"' t
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
RALEIGH, NC 27699-1636 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: f3 1 V 1J y v - 1 PERMIT#: JSrGG --)/)7 EXPIRATION DATE: '-T'-'i7 3i <-1
Non-Discharge UIC
Permit Name (if different): �.��
Facility Address: 3S V /7 FF-1. �'' r? NPDES .Jrf C�cr5 /
(Streap
FAE ✓ /v(- 2*:-)vi , f,1 TYPE OF PERMITTED OPERATION BEING MONITORED
(City) ' (zip) County Fn ,
Contact Person: !D r'' ya-7 / 'k- Telephone#: /1 w 2Uf4% 4�jJ —r! Lagoon Remediation: Infiltration Gallery
Well Location/Site Name: �n r- ILI Q No. of Wells to be Sampled: / Spray Field Remediation:
('f01"v`"""� Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): "," For Groundwater Treatment Systems Other:
Well Depth: / Y _ ft. Well Diameter: in. Check One: El Influent (98)
Screened Interval: V ft. to ' '' ft. ❑ Effluent (99) NOTE: Values should reflect dissolved and
Depth to Water Level: // ' ft. below measuring point. colloidal concentrations.
Measuring Point(M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.: 3-�?„0 3
Gallons of water pumped/bailed before sampling: / Date sample collected: 3 `.?-7 3 Date sample analyzed:
Field analysis: pH r'''' r4&ef, Specific Conductance uMhos Laboratory Name: La's '``')"' ?
Temp. /S.•/ °C, Odor Appearance Certification No. (3`/
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified ` YES NO)
COD mg/I Nitrite (NO2) as N mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m1 Nitrate (NO3) as N mg/ Pb - Lead mg/I
Coliform: MF Total /100m1 Phosphorus: Total as P mg/ Zn - Zinc mg/I
(Note:Use MPN method for highly turbid samples) Orthophosphate mg/ Ammonia Nitrogen mg/I
Dissolved Solids: Total mg/I Al - Aluminum mg/ Other (Specify Compounds and Concentration Units)
pH (when
hen analyzed) units Ba - Barium mg/
TOCmg/I Ca - Calcium mg/
Chloride y�0 mg/I Cd - Cadmium mg/
Arsenic , J mg/I Chromium: Total mg/
Grease and Oils J� l p mg/I Cu - Copper mg/
Phenol mg/I Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate mg/I Hg - Mercury mg/ (Specify test and method #. Attach lab report.)
Specific Conductance uMhos K - Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/I Mg - Magnesium mg/ VOC : method #_
TKN as N mg/I Mn - Manganese mg/ : method # =
: method # =
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 North Carolina DWG(former{ DEM)certified laboratory.I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations. -r r
Permittee or AuthoriLec�,�gent)Name and Title-Please print or type _ .-,
GW-59 / J 7 Z Z ,
Signatu Fre`m teb(dr Authorized Agent) (Date)
Rev. 03/2000 111 L

µ r
� . 1
1
SUBMIT FORM ON YELLOW PAPER ONLY
r Mail Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES""' 1
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
FACILITY INFORMATION RALEIGH, NC 27699-1636 Phone: [phone]
Pease Print Clearly or Type
Facility Name' fVi1J« ,,ds PERMIT#: J./CO j ' EXPIRATION DATE: -TT•)7 "1 a '2
Permit Name (if different): Non Discharge UIC
Facility Address: 777 il A(5`'-4 AcL NPDES Nc D )/ C 7`'
r (skeet) N - $''''// County A , '/`" TYP OF PERMITTED OPERATION BEING MONITORED
/� aim
Contact Person: /� ���' � 34 Telephone #:f>/3)„ 4 2..t/ /) Lagoon Remediation: Infiltration Gallery
Well Location/Site Name: )'V"-3(4=# 3 No. of Wells to be Sampled: / Spray Field Remediation:
ItfO"'°tni°) Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): ` For Groundwater Treatment Systems Other:
Well Depth: a`i ft. Well Diameter: _ in. Check One: ❑ Influent (98)
Screened Interval: /L/ ft. to j % ft. 0 Effluent (99) NOTE; Values should reflect dissolved and
Depth to Water Level: /7 ft. below measuring point. colloidal concentrations.
Measuring Point(M.P.) is: ft.above land surface. Relative M.P. Elevation in ft.. -3.z) d
Gallons of water pumped/bailed before sampling: 3 k.- Date sample collected: 3"..27 7 Date sample analyzed:
Field analysis: pH S Jl , Specific Conductance uMhos Laboratory Name: 2-,2„f,''a`�''`-k'"'N
Temp. As °C, Odor Appearance Certification No. �`1
PARAMETERS (Samples for metals were collected unfiltered • YES NO and field acidified r' YES NO)
COD mg/ Nitrite (NO2) as N 1cP).c>, mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m Nitrate (NO3) as N `/, mg/ Pb - Lead mg/I
Coliform: MF Total /100m Phosphorus: Total as P mg/ Zn - Zinc mg/I
(Note:Use MPN method for highly turbid samples) Orthophosphate OP> mg/ Ammonia Nitrogen lo.� mg/I
Dissolved Solids: Total -72- mg/ Al - Aluminum / U', mg/ Other (Specify Compounds and Concentration Units)
pH (when analyzed) units Ba - Barium mg/
TOC o.( mg/ Ca - Calcium mg/ 5,4,,i� 46;5 </;
Chloride /-2/ mg/ Cd - Cadmium mg/
Arsenic mg/ Chromium: Total mg/ J`✓•7i e- t p..'n� dl.�a r^,s.4--
Grease and Oils mg/ Cu - Copper mg/
Phenol mg/ Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate . s mg/ Hg - Mercury mg/ (Specify test and method #. Attach lab report.)
Specific Conductance uMhos K - Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/ Mg - Magnesium mg/ VOC : method#_
TKN as N mg/ Mn - Manganese mg/ : method # =
•
: method #
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 North Carolina DWQ(formerly DEM)certified laboratory. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Tifr-rl-k p-i,-)--, " /'fum--1- tir71
Permittee(or Authotiied A9ent) lame and Title-Please print or type
GW-59 ('d
ii((2 -
s / 2 /2 3
signatur ofdt orIhonzed Agent) (Date)
Rev. 03/2000

., ,v
SUBMIT FORM ON YELLOW PAPER ONLY
4,
•
Mail Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES^" 1
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
RALEIGH,NC 27699-1636 Phone:[phone]
FACILITY INFORMATION -; I� l) Please Print Clearly or Type
liA✓/ V A//2 ,�`,,_ PERMIT#: I✓- r r� EXPIRATION DATE: -,17 `1 P"f-
Facility Name: / Non-Discharge UIC
Permit Name (if different):
Facility Addre s: JS (/ /f ,. -✓ Atr<_ NPDES .11'7c LD f 9)0
f=.:Vv-f/ panel) C/c- 3-e 3v// County )DH p 1'm TYPE OF PERMITTED OPERATION BEING MONITORED
Contact Person. K J---Yov'q-i ,ij, `fit/� (�'D1 7/3/3 I i�7-`/)// /
Lagoon Remediation: Infiltration Gallery
Telephone#:
Well Location/Site Name: c,/1--, #y No. of Wells to be Sampled: E' Spray Field Remediation:
('`°" °eT 1t Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): lJ-'`! For Groundwater Treatment Systems Other:
Well Depth: ; 7 ft. Well Diameter: , in. Check One: ❑ Influent (98)
Screened Interval: It. to ft. El NOTE: Values should reflect dissolved and
Depth to Water Level: -'i/'-2 ft. below measuring point. Effluent (99) colloidal concentrations.
Measuring Point(M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.: 3"�>- a3
Gallons of water pumped/bailed before sampling: Date sample collected: 3... )-,i_3 Date sample analyzed:
Field analysis: pH 7' Specific LaboratoryName: y'�"''� �%^{�Y p c Conductance uMhos �
Temp. /1.3 °C, Odor Appearance Certification No. nL�
PARAMETERS (Samples for metals were collected unfiltered iYES NO and field acidified • YES NO)
COD mg/ Nitrite (NO2) as N z D.c- mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m Nitrate (NO3) s N Ll �s m /
( 3) g Pb - Lead mg/I
Coliform: MF Total /100m Phosphorus: Total as P mg/ Zn - Zinc mg/I
(Note:Use MPN method for highly turbid samples)
mples) Orthophosphate D./5 mg/ Ammonia Nitrogen -' mg/I
Dissolved Solids: Total mg/ Al - Aluminum 0 SJ mg/ Other (Specify Compounds and Concentration Units)
pH (when analyzed) units Ba - Barium mg/
TOC -7 mg/ Ca - Calcium mg/ 3 ,i---- 3 '> r-.5h-
Chloride ,3L27 mg/ Cd - Cadmium mg/
Arsenic mg/ Chromium: Total mg/ itri-h tom- 7 1lvL.,zi y -'-(-; .n /ic
Grease and Oils mg/ Cu - Copper mg/
Phenol mg/ Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate 5-3 mg/ Hg - Mercury mg/ (Specify test and method #. Attach lab report.)
Specific Conductance uMhos K - Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/ Mg - Magnesium mg/ VOC : method #_
TKN as N mg/ Mn - Manganese mg/ : method # =
: method #=
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 North Carolina DWQ(formerly DEM)certified laboratory. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations.
Permittee r Authorized nt)Name and Title-Please print or type
GW-59 sib ur q r it or luthorized Agent) 5/ 7 / �te)
Rev. 03/2000 l

- 1 I
SUBMIT FORM ON YELLOW PAPER ONLY '•Mail Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES" 1
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
FACILITY INFORMATION RALEIGH,NC 27699-1636 Phone:[phone]
lease Print Clearly or Type
Facility Name: i'J�i V.c/1`y roc,& PERMIT#: AK- �' f�9 °EXPIRATION DATE: �./.7 31 A. 1-tY
Permit Name (if different): Non Discharge UIC
Facility Address: .SV N R, '"-•-f /'.ems NPDES /V<O�� 1 c70
( .; ;� (street)
iGnyi /14 3 'Gl County /D�"i' TYPE OF PERMITTED OPERATION BEING MONITORED
Contact Person: /D�''�'lefj i ���� (LEI Telephone #: ��� e J/�1 Lagoon Remediation: Infiltration Gallery
Well Location/ Site Name: � or t, .,c. A, �t5 No. of Wells to be Sampled: Spray Field Remediation:
(`rorn Permit) Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): LJ -✓ For Groundwater Treatment Systems
stems Other:
Well Depth: /e/ ft. Well Diameter.: .,= in. Check One: El Influent
Screened Interval: `7 ft. to 7// ft. 0 Effluent (99) NOTE: Values should reflect dissolved and
Depth to Water Level: J1 (5' ft below measuring point.
colloidal concentrations.
Measuring Point(M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.: 347-•a 3
Gallons of water pumped/bailed before sampling: "`%2• Date sample collected: 3-...� :3-3 Date sample analyzed:
Field analysis: pH J ' I , Specific Conductance uMhos Laboratory Name: tr 2cy' �Z'4�
Temp. /5.-)-- °C, Odor Appearance Certification No. it. iV/
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified • YES NO)
COD mg/ Nitrite (NO2) as N ��c.)a mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m Nitrate (NO3) as N 9 os mg/ Pb - Lead mg/I
Coliform: MF Total /100m Phosphorus: Total as P mg/ Zn -Zinc mg/l
(Note:Use MPN method for highly turbid samples) Orthophosphate u,/J mg/ Ammonia Nitrogen C o Q mg/I
Dissolved Solids: Total /:; I mg/ Al - Aluminum 3�- mg/ Other (Specify Compounds and Concentration Units)
pH (when analyzed) units Ba - Barium mg/
TOC .r 0 mg/ Ca - Calcium mg/ -.I 3.;6 i-' Ii
Chloride /7 mg/ Cd - Cadmium mg/
Arsenic mg/ Chromium: Total mg/ Ar,`fazrri,7 triTr: ca3-- r-,i /2
Grease and Oils mg/ Cu - Copper mg/
Phenol _ mg/ Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate <s mg/ Hg - Mercury mg/ (Specify test and method It. Attach lab report.)
Specific Conductance uMhos K - Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/ Mg - Magnesium mg/ VOC : method #=
TKN as N mg/ Mn - Manganese mg/ : method # _
: method # =
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 North Carolina DWO(formerly DEM)certified laboratory. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations. -
—
- r'6,// (5-KI...tom49., -- r✓1' Av- /6l7'72
Permittee(o Authorized Agent)Name and Title-Please print or type r
GW-59 t" S / 2 ( ?
Signatur o r tt�e or�CuOionzed Agent) (Date)
Rev. 03/2000 L/

c9
SUBMIT FORM ON YELLOW PAPER ONLY `t
Mail Original DEPARTMENT OF ENVIRONMENT&NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING: to: WATER QUALITY DIVISION,GROUNDWATER SECTION
COMPLIANCE REPORT FORM 1636 MAIL SERVICE CENTER
FACILITY INFORMATION RALEIGH, NC 27699-1636 Phone:[phone]
/�,, Please Print Clearly or Type
Facility Name: J�"�`i j //�7 r,,,t PERMIT#: 11C. -'.1 iC' AU EXPIRATION DATE: J')%j 3/ °- 4
Permit Name (if different): Non Discharge UIC
Facility Addres : 3"V /v > -.J 4 Lam. NPDES JY(`���'J ' %
P.�;,5,)i' (s"°°`) t✓<. 3y J , d TYPE OF PERMITTED OPERATION BEING MONITORED
` County J
Contact Person: J ' r ,� / ��c")c aim Telephone#: 1"/3 7. `'7,// " Lagoon— Remediation: Infiltration Gallery
Well Location/Site Name: /('P.,c L� j3 •
Spray Field Remediation:
No.of Wells to be Sampled:(from a�m,m
Rotary Distributor Land Application of Sludge
Well Identification Number(from Permit): " For Groundwater Treatment Systems Other:
Well Depth: /7 ft. Well Diameter: -- in. Check One: 0 Influent (98)
Screened Interval: T ft. to :. - ft. 0 Effluent (99) NOTE; Values should reflect dissolved and .
Depth to Water Level: 7'`' ft. below measuring point. colloidal concentrations.
Measuring Point(M.P.)is: ft.above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling:f`-`s Date sample collected: 3- ?-d Date sample analyzed: 3 �-`�-
Field analysis: pH 6 -)41 , Specific Conductance uMhos Laboratory Name: z✓f/`4„,t �-r-N
Temp. /�°' °C, Odor Appearance Certification No. 71
PARAMETERS (Samples for metals were collected unfiltered 1' YES NO and field acidified //YES NO)
COD mg/ Nitrite (NO2) as N !O pa mg/ Ni - Nickel mg/I
Coliform: MF Fecal /100m Nitrate (NO3) as N 0a > mg/ Pb - Lead mg/I
Coliform: MF Total /100m Phosphorus: Total as P mg/ Zn - Zinc mg/I
(Note:Use MPN method for highly turbid samples) Orthophosphate 0 n -, �'
Dissolved Solids: Total -��- mg/ Ammonia Nitrogen mg/I
mg/ Al - Aluminum `/5-s mg/ Other (Specify Compounds and Concentration Units)
pH (when analyzed) units Ba - Barium _ mg/
TOC 0-4-A S.S' mg/ Ca - Calcium mg/ )'wrn `/' //-
Chloride 6 mg/ Cd - Cadmium mg/
Arsenic mg/ Chromium: Total mg/ Mrii24---e-1Ai7iz ice, O. V M,;/G
Grease and Oils mg/ Cu - Copper mg/
Phenol mg/ Fe - Iron mg/ ORGANICS: (GC,GC/MS,HPLC)
Sulfate /" mg/ Hg - Mercury mg/ (Specify test and method#. Attach lab report.)
Specific Conductance uMhos K- Potassium mg/ Report Attached? Yes (1) No (0)
Total Ammonia mg/ Mg - Magnesium mg/ VOC : method#=
TKN as N mg/ Mn - Manganese mg/ : method # =
: method #
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 North Carolina DWQ(formerly DEM)certified laboratory. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations. { � �` _ �
Permittee Aut orize�Agentlakto--)---)
and Title-Please print or type
GW-59 �/ / ?(s21
sgnature, t dteeOAulhorized Agent) (Date)
Rev.03/2000 y

GW-59A COMPLIANCE REPORT FORM Permit # /V - I6 7
(Submit one each monitoring period with GW-59 forms.)
Enter date monitoring results were due.( )y ?ty Will this monitoring report (GW-59 and GW-59A) YES
be submitted after the established due date?
2 Was any required information missing on the GW-59 report forms? YES NO
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.
we l,Jct cl v
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 concentration(s)
exceeding standards in the space provided below:
�ti1 ct� I _3li:-'l / S -7 7:R,
5 - For the constituents identified In question 4 above, have standards been exceeded previously for the YES NO
same constituents)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, 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 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.
thepermittee implementing 7 Is p g previously approved actions required by the Division involving this YES NO
groundwater quality problem?
It 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 hayloft at the review and compliance
boundaries surrounding this facility. Failure to do so may su ject the permitteq to a Notice of Violation,
fines, and/or penalties.
/de/ Fel free iemPet 306 b-v 7I (2,-v
fe
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 tha lnfotinatloij submitted n.this'tx"?
report(Compliance Report GW-59A) is true and complete to the best of my
Signature of Permittee(or Authorized Agent) Date

Monitoring Well#2 Monitoring Well#3
Chlorides ppm TDS ppm Chlorides ppm TDS ppm
Date Date
11/19/2020 No water No water 11/19/2020 13 52
1/21/2021 138 315 1/21/2021 29 216
3/29/2021 14 536 3/29/2021 25 79
7/29/2021 64 377 7/29/2021 243 508
11/23/2021 689 1370 11/23/2021 281 559
1/26/2022 51 418 1/26/2022 356 538
3/29/2022 242 446 3/29/2022 232 396
7/25/2022 836 1480 7/25/2022 271 506
11/17/2022 No water No water 11/17/2022 106 295
1/27/2023 No water No water 1/27/2023 189 504
3/27/2023 No water No water 3/27/2023 121 178
Monitoring Well#4A
Chlorides ppm TDS ppm
Date
11/19/2020 284 546
1/21/2021 369 801
3/29/2021 209 416
7/29/2021 427 612
11/23/2021 613 944
1/26/2022 458 796
3/29/2022 549 1000
7/25/2022 521 987
11/17/2022 429 1000
1/27/2023 423 1570
3/27/2023 367 772
J