HomeMy WebLinkAboutWQ0007144_Monitoring - 11-2023_20231220 (2)Monitoring Report Submittal
.....................................................
Permit Number#* WQ0007144
Name of Facility:* Camp Seafarer
Month: * November
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*
Non Discharge Reports November 2023.pdf 236.46KB
PDF Only
Monitoring Well Reports November 2023.pdf 402.57KB
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%
12/20/2023
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: 12/22/2023
SUBMIT FORM ON YELLOW PAPER ONI Y
GROUNDWATER QUALITY MONITORING:
a
DEPARTMENT OF•ENVIRONMENTALQUALITY-DIV.OFWATER'RESOURCES
COMPLIANCE REPORT FORM
INFORMATION PROCESSING'UNIT
i617 MAIL SERVICE:CENTER, RALEIGH, NC 27699-1617 Phone: 919-807-6306
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date:
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe NC
28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (s{fe8i)NC 28510
County Pamlico
� Lagoon ❑ Remediation: Infiltration Gallery
(City) (stalo) (Zip)
❑ 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
/ 2
If WELL
WELL ID NUMBER (from Permit): Well 2
Date sample collected: O
J
FIELD ANALYSES:
WAS
Well Depth: 20 . ft.
Well Diameter: 2 in.
pH 0004. Si 3units Temp. oo010: r D JQ , �_-C
a0
DRY at
Depth to Water Level 82546: .G ft. below measuring point
rd< � 9 P
Screened Interval: 10 ft.
to 20
p , µMhos
ft. Sec. Cond. 000sa: ��
time
Measuring Point is 1.9 ft. above land surface
Relative M.P. Elevation: 24.2
ft.
Odor 000m: &NL
li
sampling,
check
Volume of water pumped/bailed before sampling: -,
gallons
Appearance C[L4'7'(-
here:❑
Samples for meta[s were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑
NO
LABORATORY INFORMATION I
Date sample analyzed: I' I I �� ! .� �
Y
Laboratory Name: IV�t P_' 1 �` I
A1"— (_ ir! C1q(_ Certification No. � U
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations.
COD 00336 mg. L
Nitrite (NO2) as N oo615
mg/L Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 < /100ml-
Nitrate (NO3) as N 00620 d. O mg1L Zn -Zinc 01092 mg/L
Co.i€orm: MF Total 31504 /100mL Phosphorus: Total as P oosss Q. j mg/L
(Note so MPN method for highly turbid samples:
d
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Sol ds:Total 70300 mg.1
Al -Aluminum o11os
mg/L
pH (Lab) o04m un is
Sa - Barium 01007
uglL
TOC oow mg.,L
Ca - Calcium oos-6
mg/L
Chloride 00940 Z mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug1L
Chromium: Total 01034
ugll_
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 A ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 000s5 µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia ooslo 0. 0 V7 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N: Amman)a Nitrogen, Total)
Mn -Manganese o1055
ug1L
method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug1L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Mike Askew, Director of Facilities and Boating Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
(or
GW-59 Rev.05-02-2017
SUBMIT FORM ON YELLOW PAPER ONLY
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
• • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: 919-807-6306
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date'7
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 UIC
Permit Name (if different): YMCA of the Triange Area, INC.
NPOES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe tstreeq NC 28510
County Pamlico
❑Lagoon ❑Remediation. infiltration Gallery
(City) (Stela) (zip)
X1 Spray Field ❑ Remediatlon:
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:
(irorn Permit)
SAMPLING INFORMATION
r
If WELL
WELL ID NUMBER (from Permit): WELL 5
Date sample collected: r< <O
Z�
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400:� units Temp. 000lo:r $° 7 °C
DRY at
Depth to Water Level 62546:9• ;t-S ft. below measuring point Screened Interval: 10 ft.
to 20
ft. Spec. Cond. 000sa �s, (, � µMhos
time of
sampling,
Measuring Point is 2.2 ft. above land surface
Relative M.P. Elevation: 27.7
ft.
Odor 0008s Al-'
check
Volume of water pumped/bailed before sampling:
gallons
Appearance IZ4Fb Ij /I
here:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: , J YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: rf d /� �.Z�
LaboratoryName: E�
/}Y
f �1 �' l` t4N A C /T�' j3 t-ertification No, / G
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L Pb - Lead olo51 ug1L
Coliform: MF Fecal 31616 C /100mL
Nitrate (NO3) as N 00620 < 0. O mg:L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 6. 1
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other;Specify Compounds and Concentration Units):
sa
ssolved Solids:Total 70300 its mg/L
Al -Aluminum oil or>
mg/L
pH (Lab) 00403 units
Be - Barium 01007
ug/L
TOC oo6so mg: L
Ca - Calcium 00916
mg/L
Chloride 00940 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 o1045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate oosas 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 #
Total Ammonia 00610 . / ,2 mg/L
Mg - Magnesium 00927
mg!L method #
(Ammonia Nitrogen: NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese olos5
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: -rglL 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
SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MATL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: 919 807 63Q6
FACILITY INFORMATION Please Print
Clearly or Type
PERMIT Number: Expiration Date:
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
❑Lagoon ❑Remediation: Infiltration Gallery
2744 Seafarer Rd Arapahoe s `�`' NC 28510 County Pamlico
fcevi Maid) (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:
(from Permin
SAMPLING INFORMATION
( /
if WELL
WELL ID NUMBER (from Permit): Well 6
Date sample collected: !�!
3
FIELD ANALYSES: %
7. °C
WAS
DRY
Well Depth: 20 ft.
Well Diameter: 2
in.
pH o040o:!L.211nits Temp. 00010: !
at
Depth to Water Level e2546:6.!tCft. below measuring point Screened Interval: 10
ft. to 20
ft. Spec. Cond. 00094 33, µMhos
time of
sampling,
Measuring Point is 2.75 ft. above land surface
Relative M.P. Elevation: 20.2
ft,
Odor 00085 fi
check
Volume of water pumped/bailed before sampling: gallons
Appearance CG026 ___
here:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION r
1/l %i /.z3
'1-'-r Al1"&MCM �U
Date sample analyzed:
Laboratory Name: E��•
Certification No.
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620 O Q mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 O. D mg/L
(Note: Use MPN method for highly turbod samples)
Orthophosphate 70507
mg/L Other ( Specify Compounds and Concentration Units):
issolved Solids:Total 70300 / 70 mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC amm mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 2 2 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 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 oo937
mg1L VOC 7873 method #
Total Ammonia 00610 • Oro mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NFyas N: Ammonia Nitrogen, To:al)
Mn - Manganese oloss
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%
GW-59 Rev.05-02-2017
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• •
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
e e e
1161
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
7 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: 919.807-6306
FACILITY INFORMATION Please Print Clearty or Type
PERMIT Number: Expiration Date:.
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA OF THE Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe NC
28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (Slreel) NC 28510
County Pamlico
El Lagoon ❑Remediation: Infiltration Gallery
(city) (" 1°le) (zip)
IN 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
if WELL
WELL ID NUMBER (from Permit): WELL 7
Date sample collected: C� /6
FIELD ANALYSES:
WAS
Well Depth: 12 ft.
Well Diameter: 2 in.
q
pH ooaoo:.��units Temp. 00010: � ! a °C
DRY at
Depth to Water Level 82546: GQ U G ft. below measuring point
Screened interval: 2 ft. to
12
ft. Spec. Cond. aoosa: ¢'C6, G
time of
�µMhos
sampling,
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 25.8 ft.
Odor 000ss: is �+'
check
Volume of water pumped/bailed before sampling: I
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
�3
Date sample analyzed: 111 /C I
Laboratory Name: 9wA;9-emH-Hd6. WAr80
b- L Certification No.�
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 .�' /10DmL
Nitrate (NO3) as N 00620 < O. Q
mg/L Zn -Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P oo66e C. 0 7
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 z f O mg/L
Al - Aluminum o11os
mg/L
pH (Lab) 00403 . units
Ba - Barium 01007
ug/L
TOC oosso mg/1-
Ca - Calcium oos16
mg/L
Chloride 00940 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 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 0009s µMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia ooslo 0. 0 mg/L
Mg - Magnesium 00927
mg/L. method #
(Ammonia Nitrogen; NHyas N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L , 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: 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
SUBMIT FORM ON YFI I OVJ PAPER ONLY
OEM=
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Prfn(ClearfrorType
Facility Name: Camp Seafarer
Permit Name (if different): YMCA of the Triangle Area, INC.
Facility Address: 2744 Seafarer Rd
Arapahoe _NC 28510 County Pamlico
°
Contact Person: Mike Askew Telephone#, 252-249-1111
dVell Location/Site Name: Spray Field 2 No. of wells to be sampled: 5
' from Permlr
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISIONOFWATER QUALITYdNFORMATIONPROCESSING UNIT
1617 MAIL SERVICE CENTER. RALEtGH, NC 27699-1617 Phone: (919)•733-3221
PERMIT Number: Expiration Date:
Non-DischargewP WO 7/d f: U1C
NPDES Other
TYP50F PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
' ❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
/ J
If WELL
WELL ID NUMBER (from Permit): Well 8
/C
Date sample collected: 1
FIELD ANA)_•YgSES:
f• 6 ' °C
WAS
DRY at
Well Depth: 12 ft.
Well Diameter: 2 in.
pH J un tss Temp.
/
time of
Depth to Water Level: �ft. below measuring point
Screened Interval: 2 ft. to
12 ft. Spec. Cond. 7 b • ).Mhos
sampling,
Measuring Point is 1 ft, above land surface
Relative M.P. Elevation: 15.3 ft.
Odor /�� "L
check
n
Volume of water pumped/bailed before sampling: 2-- ORr gallons
Appearance C 4���
here: ❑
Samples for metals were collected unfiltered: OYES ❑ NO
and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION '
W �d /iti T /�1+ Lrr I C/3 C 1 C
(
Date sample analyzed 3
Laboratory Name: eaAaeut� luc.
Certi ication No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal
concentrations.
COD mg/I
Nitrite (NO2) as N
m9/1
Pb - Lead mg/I
Coliform: MF Fecal /loom[
Nitrate (NO3) as N < 0.0
mg/1
Zn - Zinc mg/I
Coliform: MF Total '::�: /1ooml Phosphorus: Total as P 0.0
mg/I
(Nola: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
2
Dissolved Solids: Total 1 G mg/I
Al - Aluminum
mg/I
PH (when analyzed) . units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/1
Chloride C! mg/I
Cd - Cadmium
mg/1
Arsenic mg/l
Chromium: Total
mg/I
Grease and Oils mg/l
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/l
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/1
Hg - Mercury
mg/l Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance NMhos
K - Potassium
mg/I VOC method #
Total Ammonia + mg/[
Mg - Magnesium
mg/I method #
(Ammon a Nitrogen. NH3 as N. Ammonia Nitrogen, Total)
Mn - Manganese-
mg/1 , method #
TKN as N mg/I
Ni - Nickel
mg/[
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCS: mg/L VOC Removal%
Gw-59 Rev.112007
GW-59A COMPLIANCE REPORT FORM Permit # GPU 7/ff
(Submil one each moniforing_period with GIP-59 forts.)
j
Enter date monitoring results were due. (A 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
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
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?
YNO
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 constitue t(s) and concentration(s)
exceeding standards in the space provided below: Wj-[ L �5' Z, ri io ^ Pli f, Q-
WC-LL G c.uW P11 +,'I �
YvELL I -VW Pi, .r•
5
For the constituents identified in question 4 above, have sta.n..dards 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 S.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concenfration(s) reported, and sample c011e Lion date f each occurrence (for the last two years).
► c--t( 3- !.cam P#-130-13 lj/&), 3lq2i t 7 /1 x
,
k<4L G caw P/j f/13 , fJ,/41 1 7/1.X , 4,/;Lf
W&L '7 Cow- PH IJ-1.21
w 4,o, FH i ;Ll sx' 31�aj A 1z
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.
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 Re Tonal Office within 90 days; an evaluation maV 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 subiect the permittee to a Notice of Violation,
fines, and/or penalties. gA k�- � / 15P,r&114� G k/ pN fir-- C
i,sts tr/ v1C toRl o tlEcb r il-t Tyr wi)sw i s tcr—
R G r o,�-AL G r-f/CC la- f /JL 3
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.
"" &,4 / 62/10 3
Signature of Permittee (or thorized Agent) Date
1-1
M
GW-59A 12/8/2003