WQ0000601_GW Monitoring_20041217

ONLY
P__10
(JW
Facility Name CSX Transportation - Hamlet Wastewater Treatment Facility
Facilty Address 173 CSX Drive
Hamlet, NC 28345 County Richmond
Contact Person: MIKE GREGORY Telephone#: (910) 205E379
Well LocallaNSity Name:. see location map No. of Wells to he Sampled: a
Well Identi8cationNumber (From Permit): MWA For Groundwater Treatment
Well Depth 53.75 R Well Diameter. 4.0 in. Systems
C One:
Screened Interval: It. to ft.Influent (98)
Depth to Water Level* 43. 22 ft below measuring point ❑® Effluent (99)
Measuring point (M.P.) is: R above land surface Relative M.P. Elevation in R:
Gallons of water pumpedlbailed before sampling: 17.7 Date Sample Collected 11/08/04
Field Analysis: pH 5.5 Specific Conductance 140. uMhos
r Temp. ° C Odor Appearance
PARAMETERS: (Samples for metals were collected unfiltered X_ YES NO
COD
mgll
Coliform: Mt- Fecal
/ 100ml
Coliform: MF Total
/ 100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 45.
mgp
PH (when analyzed)
units
TOC <1,
mgp
Chloride
mgp
Arsenic <0.005
mgp
Grease and Oils
mg/1
Phenol
mgp
Sulfate
mgp
Specific Conductance
Mhos
Total Ammonia
mgp
TKN as N
.....n
PERMIT #:
Non-0ischarge
NPDES
EXPIRATION DATE:
W00000601 UIC.
TYPE OF PERMITTED OPERATION BEING MONITORED a
Lagoon
Spray Field
Rotary Distributor
X Other Monik
20D4
Remediation: Infiltration Gallery
Remediation:
Land Application
Well
NOTE: Values should reflect dissolved and collaidal concentrations C't
Date Sample Analyzed 11/17/04 C3
Laboratory Name: ENVIRONMENT 1, INC Cam.] rn
Certification No. 10 C3
and field acidified X YES NO)
Nitrite (NO2) as N
mg
Nitrate (NO3) as N 0.9
mg/I
Phosphorus: Total as P
mgp
Orthophosphate
mgry
Al - Aluminum
mgp
Be - Barium <0.1
mgp
Ca - Calcium
mgp
Cd - Cadmium <0.001
mgp
Chromium: Total <0.005
mall
Cu - Copper
mgp
Fe - Iron
mgp
Hg - Mercury
mgp
K - Potassium
mgp
Mg - Magnesium
mgp
Mn - Manganese
mgp
NI - Nickel fill sF
.Pb - Lead <0.005 mgp
Zn - Zinc mgp
Ammonia Nitrogen
Other (Specify Compou s an Lcgnaar)(($ii¢)L(ih ts)
ORGANICS: (GC, GCf 197F PLC)
(Specfy test and method #. Attach lab report)'
Report Attached? Yes_(1) No (0)
VOC : method #=
VOC : method#=

YELLOW PAPER ONL
C-
Facility Name Hamlet Wastewater Treatment Fadlity
Facllty Address CSX Transportation, Box 191A Highway 177N
Hamlet, NC 28345 County Richmond
Contact Person: M. L. GREGORY [phone]
Well Location/Sity Name: Location Map Attached
Well Identification Number. MW-2 r«Caowtlxa'orhm' msy
Well Depth: 41.48 fL Well Diameter. . 4.0 In. ago-.
Screened Interval: ft To fL ❑� Influent (98)
Depth to Water Leval 32.5 ft below measuring point ❑� Effluent (99)
Measuring point Is fL above land surface
Gallons of water pumpedlballed before sampling: 15.6
Fleld Analysis ;pH 5.7 Specific Conductance 321. uMhos
Temp. ° C Odor Appearance
(Samples for metals were collected unfiltered X_ YES
CO
Collform: MF Fecal
—mg/I
I I00ml
Collform: MF Total
-1100m1
(Note: Use MPN mettad for highly turbid samples)
- -
Dlssolved Solids Total 180.
mgll
pH (when analyzed)
units
TOC 3.41
mgll
Chloride
mgli
Arsenic <0.005
moll
Grease and Oils
mg/I
Phenol
-mg/I
Sulfate '
mgll
Specific Conductance
Mhos
Total Ammonia
mg/I
TKN as N
mall
GW59 Rev. 4198
NO 2 as N
PERMITS: EXPIRATION DATE:
Non-0Ischarge WQ0000601 UIC _
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediafion: Infiltration Gallery
Spray Field Remedia0on
_ Rotary Distributor Land Application of Sludge
X Other _Monitoring Well
NOTE Values should reflect dissolved and collaidal concentrations
Data Sample Collected 11/08/04 Date Sample Analyzed. 11/17/04.
LaboratoryName ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X_ YES NO)
NO 3 as N '
Phosphorus: Total as P _
Orthophosphate
Al -Aluminum
Be - Barium <0.1
mg/I Ni -Nickel mgn
mg/I Pb - Lead <0.005 mg/I
mgll Zn -Zinc mnil
mgll Ammonia Nitrogen
mg/I Other (Specify Cor
Ca - Calcium
I mg/I
Cd - Cadmium
<0.001 —mg/I
Chromium: Total
<0.005 mg/l
Cu - Copper
mg/l
Fe -Iron
mg/I
Hg - Mercury
mg/l
K - Potassium
mg/I
Mg - Magnesium
rngfi
Mn - Manganese
mg/I
ORGANICS: (GC, GC/MS, HPLC)
(Specify test and method S. Attach lab report.)
Report Attached? Yes=(1) No_(0)
VOC : method # =
VOC : method # =
VOC : method # =

Facility Name Hamlet Wastewater Treatment
CSXraB.xAFacilty Address
Contact Person: M. L G
Well Location/Sity Name:
Well Identification Number. MW-3 Far00E»dTnalnenlSY
Well Depth: 45.70 ft Well Diameter. 4.0 In.�
Screened Interval: % To It. ❑� Influent (98)
Depth to Water Level 33.5 It. below measuring point ❑e Effluent (99)
Measuring point is ft above land surface
Gallons of water pumped/balled before sampling: 19.5
Field Analysis pH 4.9 Specific Conductance 42. uMhos
Temp. ' C Odor Appearance
PARAMETERS, (Samples for metals were collected unfiltered _X_ YES
CO
mg/I
Coliform: MF call
loom]
Coliform: MF Total
/ loom]
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 65.
mg/I
pH (when analyzed)
units
TOC 1.
moll
Chloride
mg/I
Arsenic <0.005
mg/I
Grease and Oils
moll
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
Mhos
Total Ammonia
mop
TKN as N
mna
GW59 Rev.4198
PERMIT M EXPIRATION I
Non-DIscharge WQ0000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remedlation: Infiltration Gallery
Spray Field Remedlatlon
_ Rotary Distributor Land Application of Sludge
X Other Monitorina Weil
NOTE Values should reflect dissolved and collaidal concentrations
Date Sample Collected 11/08/04 Date Sample Analyzed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified X YES NO)
NO 2 as N
mg/I
NO 3 as N
mg/I
Phosphorus: Total as P
moll
Orthophosphate
mg/I
AI -Aluminum
mg/I
Ba - Barium <0.1
mgfi
Ca - Calcium
Cd-Cadmium <0.001
—mg/I
moil
Chromium: Total <0.005
moll
Cu -Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/1
Mn - Manganese
mail
NI - Nickel mg/I
Pb,- Lead <0.005 mg/I
Zn -Zinc mg/I
Ammonia Nitrogen mgll
Other (Specify Compounds and concentration units)
_OVED
ORGANICS: (GC, GUMS, HP ) 2005
(Specify test and method #. Ali 3ch lab report.)
VOme_
eportAttached7Yes(�, r&dQ)YLLEREGI0NAL0FRCE
VOC : method # _
vnr. a _

SUBMIT FORM
Facility Name Hamlet Wastewater Treatment Facility
Facllty Address CSX Transportation, Box 191A Highway 177N
Hamlet, NC 28345 County Richmond
Contact Person:' M. L. GREGORY [phone]
Well Location/Site Name: Location Map Attached
Well Identification Number MW-4 FcrGMWe terTM2bWtsys1M
Check One:
Well Depth: 47:45 ft. Well Diameter. 2_0 In.
Screened Interval: ft.To ft.Influent (98)
Depth to Water Level 30.7 fL below measudng point ❑o Effluent (99)
Measuring point Is f . above land surface
Gallons of water pumped/balled before sampling: 7.8
Field Analysis pH 5.8 Specific Conductance 154. uMhos
Temp. e C Odor Appearance
(Samples for metals were collected unfiltered _X YES
CO
mall
Collform: MF Fecal
/ 100ml
Coliform:,MF Total
' /100ml
(Note: Use MPN method for highly turbid samples).
Dissolved Solids Total 90.
mall
pH (when analyzed)
units
TOC 1.93
mall
Chlodde _
mall
Arsenic <0.005
mall
Grease and Oils
mall
Phenol
mall
Sulfate
mall
Specific Conductance
Mho;
Total Ammonia
mall
TKN as N
mall
GW-59 Rev. 4/98
PERMIT M EXPIRATION DATE:
Non-DIscharge W00000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediatton: Infiltration Gallery
Spray Field Remedlaflon . -
Rotary Distributor Land Application of Sludge
X Other Monitoring Well
NOTE Values should reflect dissolved and collaldal concentrations
Date Sample Collected 11/08/04 Date Sample Analysed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X YES NO)
NO-2 as N
mall
NO-3 as N
mall
Phosphorus: Total as P
mall
Orthophosphate
mall
AI -Aluminum
mail
Be - Barium <0.1
mall
Ca - Calcium
mall
Cd-Cadmium <0.001
man
Chromium: Total <0.005
mall
Cu - Copper
mail
Fe - Iron
mall
Hg - Mercury
mg/I
K - Potassium
mall
Mg - Magnesium
mail
Mn - Manganese
mg/I
NI - Nickel mall
Pb - Lead <0.005 mall
Zn -Zinc mall
Ammonia Nitrogen mall
Other (Specify Compounds and concentration units)
2 2005
YMWw 1 0; lily, ww e"' nZ 'n F YrhFViLLEREGIONALOFAGE.
(Specify test and method #.'Alfa LrJ port.)
Report Attached? Yes_(1) No_(0)
VOC : method # =
VOC : method # =
-VOC : method#=

FORM ON YELLOW PAPER ONLY
Facility Name Hamlet Wastewater Treatment Facility
Facllty Address CSX Transportation, Box 191A Highway 177N
Hamlet; NC 28345 - County Richmond
Contact Person: M. L GREGORY [phone]
Well Location/Sity Name: Location Map Attached
Well Identification Number. MW-5 FaGourw"taTraamemsygem
Cle&Om:
Well Depth: 52.92 ft. Well Diameter. 2.0 In.
Screened Interval: ft.To ft.❑v Influent (98)
Depth to Water Level 36.7 ft below measuring point ❑® Effluent (99)
Measuring point is ft. above land surface
Gallons of water pumpedlballed before sampling: 7.8
Field Analysis pH 5.3 Specific Conductance 156. uMhos
-Temp. °C Odor Appearance
(Samples for metals were collected unfiltered _X YES
CO
mull
Collform: MF Focal
/ 100ml
Colifonn: MF Total
/ 100mi
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 101.
mgll
pH (when analyzed)
units
TOC 1.44
mull
Chloride
mgll
Arsenic <0.005
mgfi
Grease and Oils
mgll
Phenol
mg/I
Sulfate
mall
Specific Conductance
Mhos
Total Ammonia
mgli
TKN as N
mall
PERMIT #: EXPIRATION I
Non -Discharge WQ0000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation
Rotary Distributor Land Application of Sludge
X Other Monitoring Well
NOTE Values should reflect dissolved and collaldal concentrations
Date Sample Collected 11/08/04 Data Sample Analyzed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X YES NO)
NO 2 as N
mgll
NO_3 as N
mgfi
Phosphorus: Total as P
mgfi
Orthophosphate
mgn
AI - Aluminum
mgll
Be - Barium <0.1
mgll
Ca - Calcium
mgll
Cd-Cadmium <0.001
mgfi
Chromium: Total 0.008
mgll
Cu - Copper
mgll
Fe - Iron
mg/I
Hg - Mercury
moll
K - Potassium
mgli
Mg - Magnesium
mg/I
Mn - Manganese
mgll
NI - Nickel mgfi
Pb - Lead <0.005 mgfl
Zn -,Zinc mg/I
Ammonia Nitrogen mg0
Other (Specify Compounds and concentration units),
2005
ORGANICS: (GC, GUMS, H C)
(Specify test and method #. cw I" 1k REGIOEf NAL OFRCE
Report Attached?Yes_(1) No_(0)
VOC : method#=
VOC : method # =
Name And Title - Please print or
�L+ ll _•._� r mat/G
-ern-rr-�

Facility Name Hamlet Wastewater Treatment
Fadlty Address CSX Transportation, Box 191A Highway 177N
Hamlet, NC 28345 County Richmond
Contact Person: M. L. GREGORY [phone]
Well Location/Sity Name: Location Map Attached
Well Identification Number: MW-6 Fm ranm Iu TreW Ht SyslM
Check Ore:
Well Depth: 48.35 ft. Well Diameter: 2.0 In.
Screened Interval: ft.To ft ❑© Influent (9
Depth to Water Level 34.7 It. below measuring point ❑® Effluent (99)
)
Measuring point Is f . above land surface
Gallons of water pumpediballed before sampling: 6.3
Field Analysis pH 5. Specific Conductance 31. uMhos
Temp. ° C Odor Appearance
PARAMETERS: (Samples for metals were collected unfiltered _X_ YES
CO
mg/I
Collfonn: MF Fecal
/ 100ml
Collform: MF Total
/ 100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 42.
mgll
pH (when analyzed)
units
TOC 1.02
mg/I
Chloride
mg/1
Arsenic <0.005
Grease and Oils
Phenol
Sulfate mg/I
Specific Conductance Mhos
Total Ammonia mgll
TKN as N mg/I
PERMIT #: EXPIRATION I
Non -Discharge W00000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediatlon
Rotary Distributor Land Application of Sludge
X Other Monitoring Well
NOTE Values should reflect dissolved and collaidal concentrations
Date Sample Collected 11/08/04 Date Sample Analyzed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X_ YES NO)
NO_2 as N
mg/1
NO-3 as N
mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/I
AI -Aluminum
mg/I
Be - Barium <0.1
mg/I
Ca - Calcium
mg/I
Cd - Cadmium 0.002
Chromium: Total 0.018
—mg/I
mgfl
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mgfl
Mn - Manganese
mg/I
Ni - Nickel mg/I
Pb - Lead <0.005 mg/I
Zn -Zinc mall
Ammonia Nitrogen mg/I
Other (Specify Compounds and concentration units)
12 2005
ORGANICS: (GC, GC/MS, HPLC) i ocNR..rA t � fLLEREGIONALOFR
(Specify test and method #. Attach lab r pbiLy —
Report Attached?Yes_(1) No_(0)
VOC : method#=
VOC : method # =
VOC : method#=
Name Vd Title - Please print or
GW59 Rev. 4198 Wnatute orP9FIttee (or Authwiied Agent) ' ' DATE

FORM ON YELLOW PAPER ONLY
Facility Name Hamlet Wastewater Treatment Facility
Facllty Address CSX Transportation, Box 191A Highway 177N
Hamlet, NC 28345 County Richmond
Contact Person: M. L. GREGORY [phone]
Well Location/Sity Name: Location Map Attached
Well Identification Number. MW-7
Well Depth: 37.18 ft. Well Diameter. 2.0 In.
Screened Interval: ft. To ft.
Depth to Water Level 24.9 ft. below measuring poinL
Measuring point Is ft. above land surface
Gallons of water pumpedlballed before sampling:
FaG nd"Ier Tmalnent Systems
CMOs Ow:
❑© Influent (98)
❑© Efliuent(99)
6.
Field Analysis pH 5. Specific Conductance 166. uMhos
Temp. e C Odor Appearance
(Samples for metals were collected unfiltered _X_ YES
CO
mgll
Coliform: MF Fecal
/ loom[
Colifonn: MF Total
/ 100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 115.
mgll
pH (when analyzed)
units
TOC 3.36
mgll
Chloride
mg/l
Arsenic <0.005
mgll
Grease and Oils
mgll
Phenol
mg/I
Sulfate
mg/1
Specific Conductance
Mhos
Total Ammonia
mgll
TKN as N
mg/I
PERMIT #: EXPIRATION I
Non -Discharge W00000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation
Rotary Distributor Land Application of Sludge
X Other Monitoring Well
NOTE Values should reflect dissolved and collaldal concentrations
Date Sample Collected 11/08/04 Date Sample Analyzed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X_ YES NO)
NO_2 as N
mgll
NO-3 as N
mgll
Phosphorus: Total as P
mgll
Orthophosphate
mg/l
AI - Aluminum
m9/1
Be - Barium <0.1
mg/I
Ca - Calcium
Mgt[
Cd - Cadmium 0.001
mgll
Chromium: Total 0.007
mgll
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/1
Mg - Magnesium
mg/1
Mn - Manganese
mg/l
NI - Nickel moll
Pb - Lead <0.005 mg/I
Zn -Zinc Mgt[
Ammonia Nitrogen mg/l
Other (Specify Compounds and concentration units)
2805
ORGANICS: (GC, GC/MS, HP )
(Specify test and method#. fflatf46p6W).ERECIONALOFRCE
Report Attached?Yes_(1) N;_(0)
VOC : method#=
VOC : method # =
VOC : method#=
Name a%d Title - Please
GW59 Rev. 4/96 Signatute cif PMnittee (or Authorized Agent)

SUBMIT FORM ON YELLOW PAPER ONLY
Facility Name Hamlet Wastewater Treatment Facility
FaclityAddress CSX Transportation, Box 191A Highway 177N
Hamlet, NC 28345 County Richmond
Contact Person: M. L. GREGORY [phone]
Well Loeation/Sity Name: Location Map Attached
Well Identification Number: MW-B Fnr Gromfimler rrral tsystem
Check One:
Well Depth: 57.16 fL Well Diameter: 2.0 In.
Screened Interval: f . To f . ❑© Influent (98)
Depth to Water Level 36.5 ft. below measuring point. ❑o Effluent (99)
Measuring point Is fL above land surface
Gallons of water pumped/balled before sampling: 9.6
Field Analysis pH 4.9 Specific Conductance 245. uMhos
Temp. ° C Odor Appearance
PARAMETERS: (Samples for metals were collected unfiltered _X YES
CO
mg/l
Coliform: MF Fecal
/ loom[
Collfonn: MF Total
/ 100m1
(Note: Use MPN method for highly turbid samples)
Dissolved Solids Total 157.
Mgt[
pH (when analyzed)
units
TOC 2.32
mg/I
Chloride
mg/I
Arsenic <0.005
mg/1
Grease and Oils
mg/I
Phenol
mg/l
Sulfate
mg/I
Specific Conductance
Mhos
Total Ammonia
mg/I
TKN as N
mall
NO-2 as N
NO-3 as N
Phosphorus:
Orthophosphate
PERMIT #: EXPIRATION DATE:
Non -Discharge WQ0000601 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remed[atlon
Rotary Distributor Land Application of Sludge
X Other Monitorina Well
NOTE Values should reflect dissolved and collaidal concentrations
Date Sample Collected 11/08/04 Date Sample Analyzed 11/17/04
Laboratory Name ENVIRONMENT 1, INC
Certification No. 10
NO and field acidified _X_ YES NO)
mg/l NI -Nickel
Mgt[ Pb - Lead
tal as P mgfl
mgll
Al -Aluminum
mgfl
Be - Barium <0.1
mg/I
Ca - Calcium
mg/I
Cd - Cadmium <0.001
mgfl
Chromium: Total 0.016
mgll
Cu - Copper
mgll
Fe - Iron
mg/I
Hg - Mercury
mg/l
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mgll
mg/I
<0.005 mgn
Zn -Zinc mg/I
Ammonia Nitrogen mgfl
Other (Specify Compounds and concentration units)
ORGANICS: (GC, GGNj$ PLC)
(Specitytestand meth +�#��cFi�aliife j41
Report Attached? Yes_([) No(0)
VOC : method # =
VOC : method # =
VOC : method # =

GW-59A COMPLIANCE REPORT FORM Permit # OUt7o (,O
(Suhmir oi�r each monitoring period with G{{-59 forms.)
1
Enter date monitoring results were due. I - 8 - o WIII this monitoring report (GW-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
NO
IF the answer to question f 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.
X
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 OjJ21cejorguidance.
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 41s "YES" list the affected wells individually with constiluent(s) and concentration(s)
exceeding standards in the space provided below:
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?
1f the answer to question 5 is NO", skip to section 8.
If the answer to question 51s "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 maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. if the answer Is `NO", monitoring wells maybe 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 subiect the permittee to a Notice of Violation,
fines, and/orpenalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby ackn6wledge that the above Infonnafiogwas evaluated and thelntm foat(on submiedttn ffiWV 7,
report (Compllanc Re G )Js true and:complete tit the best of my knowledge . , �eA``
7 U
Signature o Pe i ee ( uthorized Agent) Dale
C V-i9A 121R/2001