WQ0000185_Monitoring - 09-2023_20231031

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * September
Report Information
Type *
GW-59
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
WQ0000185
Ocean Sands WWTP
Year:* 2023
Upload Document*
Ocean Sands GW59.pdf 269.39KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Rod Holley
Reviewer: Wanda.Gerald
10/31 /2023
This will be filled in automatically

Is the project number correct?* WQ0000185
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 11/6/2023

GW-59A COMPLIANCE REPORT FORM[ Permit # a t900V kP;-
(Submit one each monitoring period with GW-59 forms.)
Enter date monitoring results were due. 0 2 Will this monitoring report (GW-59 and GW-59A1
YES
r O
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
O
1F 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
140
identification plate, area overgrown, etc.)? Ifthe anssver is "Yes", contact theRegiorzol Offceforgzzidance.
4
Are any monitored constituents equal to or above the established standards?
ES
NO
If the answer to question 4 is NO", skip to section S.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentrations)
exceeding standards in the space, provided below: M W --7 M W -
mW-y mW'"5 w- G 76S-5LA A)7.?
�" 0D S 5 Z N
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, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
mw-;-i mw 5 mw L_ MW-7 rnvu-g
l
i�S itsS ToS 1-1)A"5 /VA5
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
LO
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 impropefly
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. �2�rr g
m � j 02 1J z72)L � �4 r,J �' d Owo,4 l7rl�
r
4,n1`1t�' , n►C/ u ,tv t� C N, n ,
CoNW�i r2,
(tq Ac-k P�z- 2, PAWV V13 lti nr.�in vA dk,
Q 1 r,�v�.l•�'�
"e.
15 Vit i
8
The person completing this po ion (GW-59A) of the monitoring report should sign below and submit 6his
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_hnowiedge.
J L4 /0 111e, 3
Signature of Permittee (or Authori ed Agent) Date
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
pEP.ARTMENT OF ENwRoNMENT:'8 NATURAL RESOURCES ,
GROUNDWATER QUALITY MONITORING:
DIVISION 0 WAFER QUALITY iNFORMATiON PROCESSING UNIT
COMPLIANCE REPORT FORM
761,7:4AILSERVICECENTER 0A E' IGH,NC27fi99161,7 Phone,{9i9).733322i; ;
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00000185 Expiration Date: 6130l2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Corolla (Street) NC 27927 County Currituck
(city) (state)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump Other: Infiltration
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW4
Date sample collected: 9/19/23
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 7.5 units Temp. 000to: 25.4 °C
DRY at
Depth to Water Level 82546:9.8 ft. below measuring point Screened Interval: 12 ft.
to 17 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:
4.0
gallons
Appearance Tan
here:
❑
Samples for metals were collected unfiltered: 21 YES
❑ NO and field acidified: [I YES
El NO
LABORATORY INFORMATION
Date sample analyzed:9/19123
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead oio51 uglL
Coliform: MF Fecal 31616 1
/100mL
Nitrate (NO3) as N 00620 2.26
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 8.25
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7030o 568
mg/L
Al - Aluminum ollo5
mg/L
PH (Lab) 00403 7.5
units
Be - Barium 01007
ug/L
TOC oo6so 6.3
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 184
mg/L
Cd - Cadmium 01027
ug/L
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 01045
uglL (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
uglL Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 00610 14.3
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug1L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Aqent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
mg/L VOC Removal%
10/29/23
(uate)
GW-59 Rev.212010

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENYIRONMENT`8 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DNISION OF WATER 66ALITY4NFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
i
fell TMAIL,SERViCE CENTER, RAcEI,GIi, NC 27699,1617 -Phone ,[phone]
FACILITY INFORMATION
Please Print Glearly or type
PERMIT Number: W00000185 Expiration Date: 6/30/202.4
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (Street) NC
27927 County Gurrittlek
❑ Lagoon ❑ Remediation: Infiltration Gallory
(city) (state)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No, of wells to be sampled: 5
❑ Water Source Heat Pump © Other: Infiltration
(from Permit)
SAMPLING INFORMATION
IF WELL
WELL ID NUMBER (from Permit): MW5
Date sample collected: 9/19123
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 6.7 units Temp. 000io: 25.7 °C
DRY at
Depth to Water Level 82546:5.2 ft. below measuring point Screened Interval: 12 ft. to
17
ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 2 ft, above land surface
Relative M.P. Elevation: ft.
Odor =85: None
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Clear
here:
❑
Samples for metals were collected unfiltered: 0 YES
El NO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:9119123
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <1
1100ml-
Nitrate (NO3) as N 00620 <0.02
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 1.93
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 7030o 576
mg/L
Al - Aluminum o11o5
mg/L
PH (Lab) 00403 6.7
units
Ba - Barium 01007
ug/L
TOC 00680 8.8
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 195
mg/L
Cd - Cadmium 01027
ug/L
Arsenic a1002
ug1L
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 (1) ❑ No (0)
pecific Conductance oo095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 006101.6
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:
Rod Holley Wastewater Superintendent Trainee
Perm ittee (or Authorized Agent) Name and Title - Please print or type
mg/L VOC Removal%
10/29/23
(Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMI;NT:;OF ENVIRONMENT &NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
Mone
DIVISION OF WATER QUALITY INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617%MAILSERVICECENTER,'RALEIGH;NC27699'16i7 Ph(919)_733-3221.'
FACILITY INFORMATION
Please P'iiuf Cleady fit Type
PERMIT Number: W00000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (sheet) NC
27927 CountyCurrituck
El Lagoon n Remediation: Infiltration Gallery
(city) (state)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump © Other: Infiltration
(from Permit)
SAMPLING INFORMATION
if WELL
WELL ID NUMBER (from Permit): MW6
Date sample collected: 9/19/23
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in,
pH 00400: 7.5 units Temp. 00010; 25.2 °C
DRY at
Depth to Water Level 82546:6.2 ft. below measuring point Screened Interval: 12 ft,
to 17 ft. Spec. Cond. 00094: µ Mhos
time of
sampling,
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft. Odor 00065: None
check
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:9/19123
Laboratory Name: Enviro Chem
Certification No. 94
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 ug1L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 3.49
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 1.92
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 703oo 524
mg/L
Al -Aluminum olim
mg/L
pH (Lab) 00403 7.5
units
Ba - Barium 01007
ug/L
TOG oo68o 6.8
mg/L
Ca - Calcium oosls
mg/L
Chloride 00940 187
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug1L
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 78732: method #
Total Ammonia 00610 9.8
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese olo55
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: mg1L Effluent Total VOCs:
mg/L VOC Removal%
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• •
DEPARTMENT;OF ENVIRONMENT,,& NATURAL RESOURCES `?
DIVISION OF WATER QUALETY MFORMATtON PROCESSING UNIT
COMPLIANCE REPORT FORM
•
• • •
1fi 7,,M' SERVICE CENTER, RALEIGH, NC 27699 i617 Phone, {Q19):7333221 ..`
FA(;IL,I I Y INFQRMAI tS2N
ter ae Priu(Clearly or ryl,e
PFRMIT Number- W00000185 Fxpiratinn (lava• 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (street) NC
27927 Count y Curntuck
El Lagoon ❑Remediation: Infiltration Gallery
(City) (State)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑■ Other: Infiltration
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW7
Date sample collected: 9/19/23
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
H 00400: 7.3
p units Temp. 00010: 25.6 °C
DRY at
Depth to Water Level 82546:4.5 ft. below measuring point Screened Interval: 12 ft.
to 17
ft. Spec. Cond. o0094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor o00m: None
sampling,
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: R1 YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:9/19/23
Laboratory Name: Enviro Chem
Certification No. 94
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 ug1L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.05
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 1.40
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 703oo 548
mg/L
AI - Aluminum 01105
mg/L
PH (Lab) 00403 7.3
units
Ba - Barium 01007
ug1L
TOG 00680 6.7
mg/L
Ca - Calcium o0916
mg/L
Chloride 0094o 225
mg/L
Cd - Cadmium 01027
ug/L
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 01045
ug1L
(Specify test and method M ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 00610 3.9
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3asN; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
uglL
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Agent) Name and Title - Please print or type
POLV/lft
Signature of Permittee (or Authori ed Agent)
mg/L VOC Removal%
10/29/23
(Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITYdNFORMATION PROCESSING,UNI7
COMPLIANCE REPORT FORM
1617,kML` SERVICE CENTER, RALEIGH NC 27699-1617 'Phone, (819);733 3221;
FACILITY INFORMATION
Please Print
Clearly or Type
PERMIT Numbor• WQ0000185 Expiration Dato: 6/30/2024
Facility Namo: Ocean Sands
Non -Discharge UIC
Permit Namo (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (street) NC
27927 County Cuiriluck
❑ Lagoon ❑ kemediation: Infiltration Gallery
(city) (State)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑■ Other: Infiltration
from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW9
Date sample collected: 9/19/23
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 7.2 units Temp. 000lo: 22.7 °C
DRY at
Depth to Water Level 82546:6.3 ft. below measuring point Screened Interval: 12 ft. to
17
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:
5.0
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: R] YES
❑ NO and field acidified: El ❑ NO
LABORATORY INFORMATION
Date sample analyzed:9/19123
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 1.81
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 1.57
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 498
mg/L
Al - Aluminum ollo5
mg/L
pH (Lab) 00403 7.2
units
Ba - Barium 01007
ug/L
TOC 00680 4.6
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 198
mg/L
Cd - Cadmium 01027
uglL
Arsenic 01002
uglL
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
uglL
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00946
mg/L
Hg - Mercury 71900
ug1L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia oo610 7.8
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganose 01055
ug1L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug1L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
I certifylthat, to'the best of my knowledge and belief, the informationsubmitted in this'report is.lrue ,acc
DWQ-certified laboratory. lam aware that there are significant penalties for submitting false informatioi
'o. Holley Wastewater Superintendent
mg/L Effluent Total VOCs:
mg/L VOC Removal%
10/29/23
Permittee (or Authorized Aqent) Name and Title - Please print or type
OW-59 Rev.2/2010
Signature of Permittee (or Authorized