WQ0000185_Monitoring - 01-2024_20240229

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * January
Report Information
Type *
GW-59
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
WQ0000185
Ocean Sands WWTP
Year:* 2024
Upload Document*
Ocean Sands GW59.pdf 254.37KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Rod. [e-mail]
Rod Holley
Reviewer: Wanda.Gerald
2/29/2024
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: 3/12/2024

GW-59A COMPLIANCE REPORT FORM Permit # WQ OaV 0 f$�
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. ( 13- • Zqj 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
NO
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?
YES
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.,in w_ g
N -�i,� h- 3Z NO-3-lis.- Iv�Tyg.Z i7)S S19
140-3- I.7
0V0.3 - / 0.2
NA3 ~ )D.9
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
S
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 mw-Cz, mw-(I )IAW- )
iJ143~1-7.9 IbS- SyZ
1 ,,- 1-7.Z N)a3-);,',0
AJA3- 3,2-
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.
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 da s• an evaluation may be
squired 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. IFQ M w � �� w ; o�40
�
Ca); -s o ,* I�-� h sue, t M � rto v� kA�J- �c
Sorry � 'S ss AA-S � ,�,� b„ m� nl c s
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,,informationsubmitted in.this
�eport,(Compllance Report GIN-49A) is true,and;complp!e 1p the best of ny knowledge
Signature of Perm ittee (or A thorized Agent) Date
GW-59A 12/812003

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT &NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY 1NFORMATION`PROCES8ING UNIT
COMPLIANCE REPORT FORM
9817 MAIL SEftVI,CE CENTER RAI SIGH NC 27699�fG17 _Phone [phone], ,,,, ,`
FACILITY INFORMATION
Please PnntClearly orType
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
NPDES Other
Permit Name (if different):
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
El 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: 1116/24
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 6.9 units Temp. 0oolo: 15.5 °C
DRY at
Depth to Water Level 82546:9.6 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 000m: None
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Tan
here:❑
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:1/16/24
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 e0,02
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 3
/100mL
Nitrate (NO3) as N 00620 0.32
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
1100mL
Phosphorus: Total as P 00665 9.89
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 703oo 499
mg/L
Al -Aluminum o1105
mg/L
pH (Lab) 00403 6.9
units
Ba - Barium 01007
ug1L
TOC 0068o 6.9
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 166
mg/L
Cd - Cadmium 01027
uglL
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
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)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia o0610 9.6
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; N1­13as N: Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug1L , method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug1L method #
For Remediation Systems Only (Attach Lab -•..Total
certify that, to the best of my knowledge and befief,'the information submitted in this report is true, acc
D1No•certified laboratory. I am aware that there are significant penalties for submittingfalse mformatioi
'.d Holley Wastewater Superintendent
Permittee (or Authorized Agent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
11
mg/L VOC Removal%
2/28124
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
DEPAI2TMEN7 OF ENVIRONMENT 8� NATURAL RESOUFI:ES
GROUNDWATER QUALITY MONITORING:
6IVIStO46FWA7ERQ6ALr1YdNF6RMATIONPR6CESSINGUNIT
COMPLIANCE REPORT FORM
16 MAiLSERVICECENTER RALEIGH,NC2769871617, Phone,,,(S49}733J221„_,_F_
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
NPDES Other
Permit Name (if different):
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (Street) NC
27927 CountyCurrituck
El Lagoon ❑Remediation: Infiltration Gallery
(City) (State)
(Zip)
❑ Spray Field ❑Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
ElRotary Distributor ElLand Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑l• Other: Infiltration
from Permit)
SAMPLING INFORMATION
if WELL
WELL ID NUMBER (from Permit): MW5
Date sample collected: 1/16/24
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 6.4 units Temp. 000lo: 13.9 °C
DRY at
Depth to Water Level 82546:5.2 ft. below measuring point Screened Interval: 12 ft. to
17 ft. Spec. Cond. 000sa: µMhos
time ofsampling,
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000ss: None
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed:1116124
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 0.03
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 18.8
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 1.47
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg1L Other (Specify Compounds and Concentration Units):
lssolved Solids:Total 70300 532
mg/L
Al - Aluminum 01105
mg1L
pH (Lab) 00403 6.4
units
Ba - Barium 01007
ug1L
TOC 00680 5.6
mg/L
Ca - Calcium oos16
mg/L
Chloride 00940 159
mg/L
Cd - Cadmium 01027
ug1L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg1L
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 10.8
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH)as N; Ammonia Nitrogen. Total)
Mn - Manganese of a55
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:
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Agent) Name and Title - Please print or type
Agent)
mg/L VOC Removal%
2/28/24
(Dale)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT &NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY INFORMATION PROCESSING UNIT;
COMPLIANCE REPORT FORM
•
• •
1617 MAIL SERVICE CENTER, RALEiGH,,NC 276419 f617 % Phone,;(919j 733221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
NPDES Other
Permit Name (if different):
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
❑Lagoon ❑Remediation: Infiltration Gallery
Corolla (street) NC 27927 CountyCurrituck
(cdy) (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: 1/16/24
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 6.4 units Temp. 00010: 14.5 °C
DRY at
Depth to Water Level 82546:6.8 ft. below measuring point
Screened Interval: 12 ft.
to 17
ft. Spec. Cond. 00094: µMhos
time of
sampling,check
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: None
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:1116/24
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo615 <0.02
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 10.2
mglL Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus:
Total as P oo665 3.81
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7030o 474
mg/L
Al - Aluminum o1105
mg/L
pH (Lab) 00403 6.4
units
Ba - Barium 01007
uglL
TOC 0068o 4.7
mg/L
Ca - Calcium 00916
mg/L
Chloride 011940 182
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
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
uglL
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)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia oo6lo 8.0
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn -Manganese o1055
uglL
,method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only Total•
I certify that; to the best of my knowledge and belief, the information submitted in this report is !rite, ace
DWO-certified laboratory. I am aware that there are significant penalties for submitting false informatio
'•• Holley Wastewater Superintendent
Permittee (or Authorized Agent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
Signature of Permittee (or AuthoVzed Agent)
mg/L VOC Removal%
2/28124
(Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
• .
PARTMENT
bEOF ENVIRONMENT &NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
bIVISION OF WATER QUALITY INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• • •
16i7MAlL SERVICE CENTER, RALEIGH ,NC76fi8,1617 Phone,(919j 733;?322i
FACILITY INFORMATION
Please Print Clearly or 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 tstreet) INC
27927 CountyCurrituck
El Lagoon ❑Remediation: Infiltration Gallery
(City) (state)
(zip)
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
ElRotary Distributor ElLand Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑>A Other: Infiltration
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW7
Date sample collected: 1/16/24
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 0040o: 6.2 units Temp. onolo: 13.4 °C
DRY at
Depth to Water Level 8254s:4.4 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: 4.5
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:1/16/24
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 o1051 ug/L
Coliform: MF Fecal 31616 <1
/10omL
Nitrate (NO3) as N 00620 3.42
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P oo665 0.87
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 7o3oo 398
mg/L
Al - Aluminum o11os
mg/L
PH (Lab) 00403 6.2
units
Ba - Barium 01007
ug/L
TOC omao 4.0
mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 140
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
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 oo610 <0.2
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn - Manganese oio55
ug1L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug1L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg1L Effluent Total VOCs: mg/L VOC Removal%
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 at analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submittingfalse information, including the possibility of fines and imprisonment for knowing violations
Rod Holley Wastewater Superintendent Trainee `(ooj, 111
Permiltee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee
GW-59 Rev.212010
2128124
(Date)

SUBMIT FORM ON YELLOW PAPER ONLY
• .
DEPARTMENT OF ENVIRONMENT &"NATURAI RESOURCES
GROUNDWATER QUALITY MONITORING:
DEVISIQN OF wA7ER QUALITY INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
9617;tNAlL SERVICE CENTER, RAIEIGH, NC 27fi99,1fi97 Phone_�;(919) 733=322i„ „
FACILITY INFORMATION
Please PdnfCleadyorType
PERMIT Number: WQ0000185 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 (street) NC
27927 County Currituck
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 X Other: Infiltration
(from Permi)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW9
Date sample collected: 1/16/24
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH 00400: 6.6 units Temp. 000to: 15.2 eC
DRY at
Depth to Water Level 82546:6.2 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 00085: None
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Clear
here: El
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:1/16/24
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 o1051 ug1L
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 1.77
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:TOtal 70300 519
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 6.6
units
Be - Barium 01007
ug/L
TOC oosso 4.1
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 170
mg/L
Cd - Cadmium 01027
ug1L
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
ug1L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 0009s
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia oomo 1.7
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH,as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L
, method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only • •
certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that €he I.a oratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submitting false information, including the'possibility.of fines. and imprisonment for knowing violations.
Rod Holley Wastewater Superintendent Trainee 2128/24
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authori*d Agent) D.
GW-59 Rev.212010