WQ0009772_Monitoring - 03-2023_20230503 (2)

Permit #:"
Name of Facility:"
Month:" March
Report Information
Type"
Revised - GW-59
WQ0009772
Monteray Shores WWTP
Year:" 2023
Upload Document"
MS MW MAR 2023 Report Signed. pdf
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:" Travis Tucker
Signature:"
Submittal Date: 5/3/2023
Will be filled out automatically.
9.39 M B

GW-59A COMPLIANCE REPORT FORM Permit
(Submit one each monitoring period with GW-59 forms.)
W
1
Enter date monitoring results were due. II this monitoring report (GIN-59 and GW-59A)
YES
NO
be submitted after the established due date.
X
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.
X
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:
M IV A[�� i DS = 77,19 //--
l.� Lj 06 1))5 = d , 3
5
For the constituents identified in question 4 above, have standards been exceeded previously for 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
standards, concentrations) reported, and sample collection date for each occurrence (for the last two years).
S AIL 4
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
X
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
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 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.
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.
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.
Digitally signed by Tony Konsul
DN: C-US, OU-= Director, State Operations', O-Carolina Water Service of NC, CN-Tony
Reason: I am approving this document
Konsul.E=Tony.Ki—.Rc,-fta
cN
Tny Kns1■
O O
■1 401Cervi.dt 2
Location. 5321 Fairview Rd, suite 401 Charlotte NC 28209/2/2023
M Date: 2023.05.02 10'.141 1-04'00'
Signature of Permittee (or Authorized Agent) Date
GW-59A 12/8/2003

Ground Water Data
Monteray Shores WWTP
Permit # WQ0009772
Permit Limit:
500
1.5
MW #
Collection
Date
TDS mg/I
Total
Ammonia
mg/I
5
3/4/2021
795
<Limit
5
7/12/2021
686
<Limit
5
11/8/2021
701
<Limit
5
4/7/2022
791
<Limit
5
7/14/2022
960
<Limit
5
11/17/2022
818
<Limit
5
3/9/2023
770
<Limit
Permit Limit:
500
1.5
MW #
Collection
Date
TDS mg/I
Total
Ammonia
mg/I
6
3/4/2021
864
1.9
6
7/12/2021
898
1.8
6
11/8/2021
892
1.7
6
4/7/2022
968
5.0
6
7/14/2022
10301
3.5
6
11/17/2022
9391
3.3
6
3/9/2023
9841
2.3
Digitally signed by Tony Konsul
DN: C=US, OU="Director, State Operations", O=Carolina Water Service of
Tony Konsu I Ro on: Tony Konsul, g E=[e-mail]
Reason: I am approving this document
Location: 5821 Fairview Rd, suite 401 Charlotte NC 28209 �f
Date: 2023.05.02 10:14:50-04'00' S/G/2O23
Foxit PDF Editor Version: 11.2.5
Signature of Permittee (or Authorized Agent) Date

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV.OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617MAJL SERVICE CENTER, RALEIGH, NC 2709-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/21/26
Facility Name: Monteray Shores WWTP
Non -Discharge WQ0009772 UIC
Permit Name (if different):
NPDES Other
Facility Address: 819 Malia Drive, Corolla, NC 27927
TYPE OF PERMITTED OPERATION BEING MONITORED
819 Malia Drive, Corolla, NC 27927-"
County Currituck
IN Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Tony Konsul
Telephone#: [phone]
ElRotary Distributor ElLand Application of Sludge
Well Location/Site Name: MW 12 West of Infiltration Pond No. of wells to be sampled: 5
❑ Water Source Heat Pump B Other: LPP Field
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW#12 West
Date sample collected: 3/9/23
FIELD ANALYSES:
WAS
Well Depth: 12.3 ft.
Well Diameter: 2 in.
pH 000lo: 7.26 units Temp. 000lo: 16.0 °C
DRY at
Depth to Water Level 82546:6.4 ft. below measuring point Screened Interval: ft.
to
ft. Spec. Cond. 00094: µMhos
time of
sampling,check
Measuring Point is 2.3 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085:
Volume of water pumped/bailed before sampling: 3.0
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: March 9,13,14,15,16,22,24, 2023
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1 /100mL
Nitrate (NO3) as N 00620 0.04
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 3.46
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 703oo 401 mg/L
All - Aluminum 01105
mg/L
pH (Lab) 00403 7.3 units
Ba - Barium 01007
ug/L
TOC 0068o 3.0 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 155 mg/L
Cd - Cadmium 01027
uglL
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L
Cu - Copper o1042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug►L
Fe - Iron o1o45
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 oog37
mg/L
VOC 7873 method # SM 6200B
Total Ammonia 00610 0.5 mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3as 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: mg/L VOC Removal%
Tony Konsul, Director, State Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
azas 10/21 /26
(Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Hease 11rmt Clearly or Type
Facility Name: Monteray Shores WWTP
Permit Name (if different):
Facility Address: 819 Malia Drive, Corolla, NC 27927
819 Malia Drive, Corolla, NC 27927' County Currituck
act Person: Tony Konsul Telephone#: [phone]
Location/Site Name: MW 13 East of Infiltration Pond No. of wells to be sampled: 5
ELL ID NUMBER (from Permit): MW#13 East
ell Depth: 11 ft.
-pth to Water Level 82546:2.0 ft. below measuring point
:asuring Point is 2.3 ft. above land surface
Date sample collected: 3/9/23
Well Diameter: 2 in
Screened Interval: ft.
Relative M.P. Elevation:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: 919-W4 306
PERMIT Number:
Expiration Date: 10/21/26
Non -Discharge W00009772
UIC
NPDES
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
n Lagoon
❑ Remediation: Infiltration Gallery
❑ Spray Field
❑ Remediation:
❑ Rotary Distributor
❑ Land Application of Sludge
❑ Water Source Heat Pump
K Other: LPP Field
to _ft.
ft.
flume of water pumped/bailed before sampling: 4.5 gallons
imples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH oo400 7.21 units
Spec. Cond. 00094:
Odor 00085
Temp. 000lo: 13.7 oC
ttMhos
DRY at
time of
sampling,
Appearance Tan here:
Date sample analyzed:March 9,13,14,15,16,22,24, 2023 Laboratory Name: Environmental Chemists, Inc.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NOS as N 00615 <0.02 mg/L Pb - Lead 01051
Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 <0.02 mg/L Zn - Zinc o1o92
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 1.31 mg/L
(Note Use MPN method for WON turbid samples)
Certification No. 37729
ug/L
mg/L
9 y Orthophosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7o3oo 371
mg/L
AI - Aluminum o11o5
mg/L _
pH (Lab) 00403 7.2
units
Ba - Barium 01007
ug/L _
TOC oo68o 3.5
mg/L
Ca - Calcium 00916
mg/L
Chloride oo94o 141
mg/L
Cd - Cadmium 01027
ug/L _
Arsenic 01002
ug/L
Chromium: Total o1o34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron o1o45
ug1L
(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 # SM 6200B
Total Ammonia 00610 0.6
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Ntrogen, 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: mg/L VOC Removal%
Tony Konsul, Director, State Operations Tony Konsul 211 ° 111.-211.1a1efse1fPaNc rnYKnu 10/21/26
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent)n 305 (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV.OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617MAIL SERVICE CENTER, RALEIGH,NC27699.1617 Phone:[phone]MW
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/21/26
Facility Name: Monteray Shores WWTP
Non -Discharge WQ0009772 UIC
Permit Name (if different):
NPDES Other
Facility Address: 819 Malia Drive, Corolla, NC 27927
TYPE OF PERMITTED OPERATION BEING MONITORED
819 Malia Drive, Corolla, NC 27927"
County Curdtuck
❑■ Lagoon ❑ Remediation: Infiltration Gallery
;�.,,rp s.;•
❑ Spray Field ❑ Remediation:
Contact Person: Tony Konsul
Telephone#: [phone]
ElRotary Distributor ElLand Application of Sludge
Well Location/Site Name: East of LP
No. of wells to be sampled: 5
❑ Water Source Heat Pump 0 Other: LPP Field
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW#4
Date sample collected: 3/9/23
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH oo400 7.09 units Temp. 000lo: 16.6 °C
DRY at
Depth to Water Level 82546:5.1 ft. below measuring point Screened Interval: 18 ft.
to 20
ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: March 9,13,14,15,16,22,24, 2023
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 <0.02
mg/L Zn - Zinc olo92 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 2.21
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7030o 424
mg/L
All - Aluminum o1105
mg/L
pH (Lab) 00403 7.1
units
Ba - Barium oloo7
ug/L
TOC 0068o 4.7
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 108
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 011134
ug1L
Grease and Oils 00552
mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron olo45
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 oo937
mg/L
VOC 7873 method # SM 6200B
Total Ammonia 00610 1.3
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; N1­13as 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:
Tony Konsul, Director, State Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
Ton Kc
Signature of ermittee (or
ng approved methods of analysis by a
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• •
DEPARTMENT OF ENMRONMEhITAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1e17MwLSERVICE CENTER RALEIGH,NC27699.1617 Phone:[phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/21/26
Facility Name: Monteray Shores WWTP
Non -Discharge VVQ0009772 UiC
Permit Name (if different):
NPDES Other
Facility Address: 819 Malia Drive, Corolla, NC 27927
TYPE OF PERMITTED OPERATION BEING MONITORED
819 Malia Drive, Corolla, NC 27927,
County Currituck
m Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Tony Konsul
Telephone#: [phone]
ElRotary Distributor ElLand Application of Sludge
Well Location/Site Name: Southwest of LPP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑■ Other: LPP Field
tram Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW#5
Date sample collected: 3/9/23
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH oo400: 7.15 units Temp. 000lo: 13.2 °C
DRY at
Depth to Water Level 82546:4.1 ft. below measuring point
Screened Interval: 18 ft.
to 20
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 000m: Swampy
sampling,
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance Greenish
here: a
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: March 9,13,14,15,16,22,24, 2023
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N o0615 <0.02
mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.24
mg/L
Zn - Zinc o1o92 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 3.10
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7o3oo 770
mg/L
AI -Aluminum o11o5
mg/L
pH (Lab) 00403 7.2
units
Ba - Barium 01007
ug/L
TOC oo68o 16.9
mg/L
Ca - Calcium 00916
mg/L
Chloride oo94o 115
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper o1o42
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 oo945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ® No (0)
Specific Conductance o0095
µMhos
K - Potassium oo937
mg/L
VOC 7873 method # SM 62008
Total Ammonia 00610 0.3
mg/L
Mg - Magnesium oo927
mg/L
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen, Total)
Mn - Manganese of o55
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%
Tony Konsul, Director, State Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
Tony Konsul ®" a.aeo,.�e« a12.I ..�rv�� .o,kov
10/21 /26
Signature of Permittee (or Authorized Agent) 203 0 (Date)
GW--59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER RALEIGH, NC 27699.1817 Phone: 91"07-6:M
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/21/26
Facility Name: Monteray Shores WWTP
Non -Discharge W00009772 UIC
Permit Name (if different):
NPDES Other
Facility Address: 819 Malia Drive, Corolla, NC 27927
TYPE OF PERMITTED OPERATION BEING MONITORED
819 Malia Drive, Corolla, NC 27902T
County Currituck
© Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Tony Konsul
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Northwest of LP
No. of wells to be sampled: 5
❑ Water Source Heat Pump © Other: LPP Field
from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW#6
Date sample collected: 3/9/23
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH oo400: 7.25 units Temp. 000lo: 13.0 °C
DRY at
Depth to Water Level 82546:5.9 ft. below measuring point Screened Interval: 18 ft.
to 20
ft. Spec. Cond. 000g4: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft. '
Odor doom: Swampy
sampling,
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance Green/Brown
here:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: March 9,13,14,15,16,22,24, 2023
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0,02
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
A00mL
Nitrate (NO3) as N 00620 0.25
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 4.38
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 984
mg/L
AI -Aluminum o11o5
mg/L
pH (Lab) 00403 7.2
units
Ba - Barium 01007
ug/L
TOC 0068o 21.3
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 136
mg/L
Cd - Cadmium 01027
ug1L
Arsenic 01002
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 ol045
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 # SM 6200B
Total Ammonia oo610 2.3
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen, N1­13as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N oo625
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%
Tony Konsul, Director, State Operations
Permittee (or Authorized Aqent) Name and Title - Please print or type
Tonv Konsul
(or Authorized Aqent)
Z6.11-111-e 10/21 /26
GM59 Rev, 05-02-2017