Maxton Oil-#13878

SUBMIT FORM ON YELLOW PAPER ONLY
Nitrite (NO2) as N mg/I
Nitrate (NO3) as N mg/I
Phosphorus: Total as P mg/I
Orthophosphate mg/l
At - Aluminum mg/I
Ba - Barium mg/I
Ca - Calcium mg/I
Cd - Cadmium mg/I
Chromium: Total mg/I
Cu - Copper mg/I
Fe - Iron mg/I
Hg - Merc ry _ mg/I
K - Potas ium mg/I
Mg - Magi lesiuw_ -I mg/I
Mn - Man, janese mg/I
FACILITY INFORMATION
Facility Name- Maxton Oi
Please Print Clearty or Type
Permit Name (if different):
Facili ty Address: 207 Id ttcbfair Streei: P 0 Box 218
rlaxLon P'"i td.C. 2836t�ounty Scotland
tan Ralph C Fi9T(Is tZOr Telephone III: /841i/5279
Contact Person:
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampled: .m f.
Well Identification Number (from Permit): (2— For Groundwater Treatment Systems
Well Depth: 11 a. 3 R .Well Diameter: 5 In. Check One:
Screened Interval: (L to ft- ❑ Influent (98)
Depth to Water Level: IS% 1 ft. below measuring point. ❑ Effluent (99).
Measuring Point is. R. above land surface. a T
Gallons of water Pum edlbailed before sampling: V
Feld analysis: pH_ , Specific Conductance uMhos
Temp. °C,Odor _LQ Appearance rn 4
PERMIT t#: EXPIRATION DATE:
Non -Discharge 13878 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
Spray Field _Remediallon:
Rotary Distributor _ Land Application of Sludge
Other:
NOTE: values should reflect dissolved and pp
colloidal concentrations-
Date sample collected: Date sample analyzed: Gj
Laboratory Name: Ox`ord Lab N
Certification No. CI Z
PARAMETERS (Samples for metals were collected unfiltered YES _NO and field acidified
COD mg/I
Cofiform: MF Fecal /100ml
Coliform: MF Total /I00ml
(Note: Use MPN method for highly turbid samplest
Dissolved Solids: Total rl mg/I
pH (when analyzed) units
TOC < 6 na mg/I
Chloride mg/I
Arsenic mg/I
Grease and Oils mg/I
Phenol mg/I
Sulfate S mg/l
Specific ConductanceuMhos
Total Ammonia mg/I
TKN as N mgll nrl : method it =
. r t rrrrw*Trrymf+rryrl
_YES _ NO)
Ni - Nickel
mg/I
Pb - Lead_
mg/I
Zn - Zinc
mg/I
Ammonia Nitrogen
mg/I
Other (Specify Compounds ar>rt(^tration
Units)
ORGANICS: (GC,GCIMS,HPLC) .
(Specify test and method R. Attach lab report.)
Report Attached? Yes_(1) No_(0)
VOC : method It _
r Aulhorir'd Agent) Name and Title - Please print or type
method tt =

SUBMIT FORM ON EYEY LOW PAPER ONLY
FACILITY INFORMATION
NG::
Please Print Clearly or Type
Facility Name: Maxton Oi
Permit Name (if different):
Facility Address: 207 N HcNai r Street P 0 BOx 218
rlaxton Id.C. 28364County - Scotland
tart Ralph C Fi�si".'as Vol. Telephoneff:910/844/5279
Contact Person:
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampled:
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: 41 fL -Well Diameter._ In. Check One:
Screened Interval: It to (t. ❑ influent (98)
Depth to Water Level: —h. below measuring point. ❑ Effluent (99).
Measuring Point is. It. above land surface.
Galt'ons of water pumpedlbailed before sampfing:�y
Refd analysis: pH (n " O S , Specific Conductance - _ uMhos Gr
q
�L�
Temp. °C, Odor JV Q Appearance
PERMIT #. EXPIRATION DATE:
Non -Discharge 13878 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field _Remedlallon: .
Rotary Distributor Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations. �
Date sample collected: Date sample analyzed: ro,
Laboratory Name: Oxford Lab / CO
-
Certification No. Alf
t1
PARAMETERS (Samples for metals were collected unlittered YES _NO and field acidified
COD mg/I
Coliform: MF Fecal _/Iuuml
Coliform: MF Total /100ml
(Nola: Use MPN method for highly turbid samplest
Dissolved Solids: Total. S� mg/I
pH (when analyzed)
units
TOC (s Z
mg/I
Chloride
mg1i
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate J 97
mg/I
Specific Conductance—%i`uMhos
Total Ammonia
mg/I
TKN as N
mg/I
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/l
At - Aluminum
mg/I
Ba - Barium
mg/I
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
Cu - Copper
mg/I
Fe - Iron
RECEIV
mg/I
mg/l
Hg - Mercury
mg/f
K - Potassiu
mg/I
Mg - Magne
ium
mg/I
Mn - Mango
ese
OENR - FAYEriEM LLE REGIONAL OFR CE
_YES _NO) ..CIO
Ni - Nickel mg/I
Pb - Lead— mg/1
Zn - Zinc mg/I
Ammonia Nitrogen-----%�— Unit
Other (Specify Compounds and t^on Units)
ORGANICS: (GC,GCIMS,HPLC)
(Specify test and method N. Attach lab report.)
Report Attached? Yes_(t) No_(0)
VOC : method N =
method If =
method R =
7lla (or AUlhodrP.d Ageng Name and Title -- Pleasn print or NPe
ri
g_,3o- a
GW-59 Rnv. A/98

SUBMIT FORM ON YELLOW PAPER ONLY
NG*
Please Print Clearly or
Facility Name• Maxton 0
Permit Name (it different):
207 IQ McNair Street P 0 Box 213
Facility Address:
Max ton "� td.C. 2836i�ounly ID �lanri
arte zc1 910/3lttl/5279
Contact Person: Ralph C Fig--]'ds Telephone9:
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampledi am
Well Identification Number (from Per (0 For Groundwater Treatment Systems
Well Depth: L/ ft. •Well Diameter. � In. Check One:
Screened Interval: ft. to ft. . ❑ Influent (98)
Depth to Water Level: 0. below measuring point. ❑ Effluent (99).
Measuring Point is.-ft. above land surface.
Gallons of water pumpedfbailed before sampling: uMhos
Refd analysis: pH_[p,; S� . Specific Conductance s
Temp °C Odor Al 0 Appearance
#: EXPIRATION DATE -
Non -Discharge 13878
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation:Infiltration Gallery
Spray Field
Rotary Distributor
Other:
Remedialion:
Land Application of Sludge
r
NOTE: Values should iellect.dissolved and Iy r
colloidal concentrations.
N
Dale sample collected: Date sample analyzed:
laboratoryName: Oxford Lab
Certification No.. w /.3 � / r
YES NO and fleld acidified _YES
PARAMETERS (Samples for "metals were collected unfiltered
mg/I Nitrite (NO2) as N
mg/I
COD
CGliform: MF Fecal _/t00ml
Nitrate (NO3) as N
Phosphorus: Total as P
mg/l
Coliform: MFTotal
/t00ml
Orthophosphate
mg t
(Note: Use MPN method for highly turbid samples)
s
m
At -Aluminum
mg/I
Dissolved Solids: Total
is
units
Ba -Barium
mg/1
pH (when analyzed)
TOC 2+�
mgH
Ca - Calcium
mg/I
mg/I
Chloride
mgpl
mg/I
Cd - Cadmium
Chromium: Total
mg/I
Arsenic
Grease and Oils
mg/I
- Copper
mg/I
mg/I
Phenol
mgll
Fe -I
Fe ron -
mg/I
Sulfate p
mg/I .
Hg - Mercur
_ RF�f`GI1
mg/l
Specific Conductance /,� p 0 uMhos
K - Potassiu
t
mg/I
Total Ammonia
mg/I
mgll
Mg - Magne
Mn -Mango
ium
ese
mg/I
TKN as N
DFNR-FAYETIENLLE REGIONAL OFHCE
NO)
Ni - Nickel
Pb - Lead_
Zn - Zinc
Ammonia Nitrogen
c—
Other (Specify Compounds and CoiSn r
e_
mg/I
mg/I
mg/I
mg/I
Units)
ORGANICS: (GC,GCIMS,HPLC) .
(Specify test and method R. Attach lab report.)
Report Attached? Yes —(I) No —(0)
VOC method N
method It =
method R =
or Authnrired Agent) (lame and Till"-Pioase print or Igpe 8-3Q_ 61
n . . 4�L
nur [n n_.. unn

FORM ON YELLOW PAPER ONLY
GFiO„l6WATf FQIJ�ILTY��l01�ITORING•
rCOMPL)ANCE REPORT FORM
FACILITY INFORMATION please Print Clearly or Type
Facility Name. Maxton O • „
Permit Name (if different): '
Facility Address: 207 b( McNair Street ? 0 Box 213
dax[on "ter N.C. 28364County , Scotland
(ay) Ralph C FidMIS h"l-Telephone 9:910/3Li.4/6279
Contact Person:
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampled: F._XF._.Tf
Well Identification N in er (from Permit): For Groundwater Treatment Systems
Well Depth: tL Well Diameter. n in. Check One:
Screened Interval: h-to ft. ❑ [nffUent (98)
Depth to Water Level: /,2• S It. below measuring point. ❑ Effluent (99).
Measuring Point is. ft. above land surface.
Galloons of water pumpedlbailed before sampling:
Fefd analysis: pH , specific Connnd''uc�/tt//ante uMhos
Temp. °C,Odor Appearance
PERMIT #: EXPIRATION DATE- -
Non -Discharge 13878 UIC
NPOES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field . Remediation: ..
Rotary Distributor
tither.
Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations.
Dale sample collected: Date sample analyzed:,
Laboratory Name: Oxford Lab t
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES
NO and field acidified
COD mg/I -
Coliform: MF Fecal /I00ml
Coliform: MF Total /100ml
(Note: Use WN.method for highly turbl sem lest mg/I
Dissolved Solids: Total D
pH (when analyzed)
units
TOC
mg/I
Chloride
mg/i
Arsenic
mg/i
Grease and Oils
Phenol
mg/l
g
Sulfate S
mg/I
Specific Conductance � 1T�umhos
Total Ammonia
mg/I
mg/I
TKN as N
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
mg/I
Phosphorus: Total as P.
mg/I
Orthophosphate
mg/f
At - Aluminum
mg/l
mg/l
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
Cu - Copper
Fe -Iron_
mg/i
g
Hg - Mercu
mg/I
K - Potassi
7-Q
mg/I
Mg - Magn ium
mg/I
Mn - Manq rijse
_NO)
_ 1%6%
_YES
Ni -.Nickel
mgXq
Pb - Lead
mg/l
Zn - Zinc
mg/I
Ammonia Nitrogen
mg/I
Other (Specify Compounds an otpttor Units)
ORGANICS: (GC,GC/MS,HPLC) .
(Specify test and method R. Attach fab report.)
Report Attached? Yes —(I) No _ (0)
VOC : method It =
method N =
method N =
r Aulherized AgentlJ'lame and Title -Please print or type ^
r,W_Fn o..,. Alan

SUBMIT FORM ON EY LLOW PAPER ONLY
NG&
Please Print Clearly or Type
Facility Name'----I-axton Oi -
Permit Name (it different): u i .
facgiryncoress: -- ,-94 - -- i Scotland
flax.. e I4.C_ 2836 bounty
tcrrl Ralph C Fi4t� ' •Telephone 9:91D/844/5279
Contact Person:
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampled: °m r� t
Well Identification Number (from Permit): / 3 For Groundwater Treatment Systems
Well Depth: ' j 1 IL -Well Diameter: 2_ In. Check One:
Screened Interval: ft. to ff- . ❑ Influent -(98)
Depth to Water Level:H. below measuring point. ❑ Effluent (99).
Measuring Point is_ ft. above land surface. ? O
Gallons of water pum edlbailed before sampling:
Field analysis: pH . Specific Conductance _UMos
420 Appearance
Temp. °G.Oder
PERMIT #: EXPIRATION VA I C
Non -Discharge 13878 UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Rerttedfation: infiltration Gallery
Spray Field
_ Rotary Distributor
dher.
Remediatlom.
Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations-;
ti•
Dale sample collectOx`ord LabDate sample analyzed: ti
LaboratoryName:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered _ YES _NO
and field acidified
mg/l
COD
mg/I .
/loom(
Nitrite (NO2) as N
Nitrate (NO3) as N
mg/l
Coliform: MF Fecal
Coliform: MF Total _/100ml
Phosphorus: Total as P.
mg/l
mg/l
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
Orthophosphate
At -- Aluminum
mg/I
pH (when analyzed)
/ 41
units
Ba - Barium
Ca - Calcium
mg/l
mg/I
TOC itmg/I
Chloride
mg/I
Cd - Cadmium
mg/I
Arcanic -
mg/t
Chromium: Total
--n
YES _ NO)
Ni - Nickel
mg/I
Pb - Lead—
mg/l
Zn - Zinc
mg/l
Ammonia Nitrogen
mg/l
Other (Specify Compound,V,d*pacenlratlon Units)

SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
Facility Name: Max on Oi
Permit Name (if different): „ i Q
t-2C11 Aocress: - a„ - Scoiland
ea on [d.C: 283ii;County
le'rl Ralph C Fi4l S' tZOI•Telephoneif:910/844/5279
Contact Person:
Well Location/ Site Name- Shaw Farm No. of Wells to be Sampled: em arm
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: li�lD R 'Well Diameter. = In. nCheckOne:Screened Interval: IL to IL influent (98)
Depth to Water Level:_ft. below measuring point. Effluent (99)
Measuring Point is. N. above land surface.
Galloons of water pumpedibailed before sampling: 0
Field analysis: pH . Specific Conductance uMhos
Temp. *C.Odor _&f) Appearance
PERMIT li EXPIRATION DATE
Non -Discharge 13878 UIC
t.r
A1-
NOTE; Values should reflect dissolved and to
colloidal concentrations. ^1
Dale sample collected: Date sample analyzed: 0.
LaboraloryName: Ox`ord Lab
Certification No. /'1 el )
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remedialian: Infiltration Gallery
Spray Feld . Remediation: -
Rotary Distributor Land Application of Sludge
r
PARAMETERS (Samples for metals were collected unfiltered YES _NO
and field acidified
mg/I
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
I Iuuml
/100ml
Nitrate (NO3) as N
Phosphorus: Total as P
mg/I
Coliform: MF Total
Orthophosphate
mg/1
(Nola: Use MPH-melhod rw highly turbid samptest.
Dissolved Solids: Total
mg/I
AI - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
mg/I
TOC D mD
mg/I
mg/l
Ca - Calcium
Cd - Cadmium
mg/I
Chloride
Arsenic
mg/I
Chromium: Total
g
mg/I
Grease and Oils
mg/I
mg/I
Cu - Copper
Fe - Iron 6 `i i
mg/I
Phenol
Sulfate / D (v
mg/I
Hg - Mercur
mg/I
mg/I
Specific Conductance / O I —uMhos
mgg
K - Potassiu
Mg - Magne 'urn mg/I
Total Ammonia
TKN as N
mg/I
Mn - Mangan
9
_YES _NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds aj 4�Vtlon Units)
ORGANICS: (GC,GCIMS,HPLC) .
(Specify test and method N. Attach lab report.)
Report Attached? Yes_(1) No _(0)
VOC : method N _
v Authorized Agenll Plamo anA Title - Pleaseprkit er type
method N =
method It =
a-3C)04_
GW-54 nuv figs
q

SUBMIT FORM ON YELLOW PAPER ONLY
4
Gc
Clearly "Type
Facility Name: Haxton Oil
Permit Name (if different): In
--r[axL-on t'near N.C. o;County
i,coL:_Lanci
tC'yl Ralph-C Fi4l'(7s ' (zp)•Tele honeH:91,3/3LiLi/5279
Contact Person: p
Well Location/ Site Name: Shaw Farm No. of Wells to be Sampled:
Well Identification Number (from Permit): For GroundwaterTreatmenl Systems
Well Depth: ' �'n fL Well Diameter. __Z_ In. Check One:
Screened Interval: ft- to ft- ❑ Influent (98)
Depth to Water Level: ` ft. below measuring point. ❑ Effluent (99).
Measuring.Poinl is. ft- above land surface. Q
Gallons of water pumpedlbailed before sampling:
Feld analysis: pH (n,R 3 Specific Conductance uMhosn
Temp. °C, Odor N 1) - - Appearance ,rn U C�—
PERMIT /1: EXPIRATION DATE:
Non -Discharge 13878 UIC
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field
Rotary Distributor
Other:
Remediation:
Land Application of Sludge
NOTE: Values should reflect dissolved and
colloidal concentrations.
Dale sample collected: Date sample analyzed: y
Laboratory Name: Oxi`ord Lab N
Certification No. i
PARAMETERS (Samples for metals were collected unfiltered YES . _No
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/1100ml
Nitrate (NO3) as N
mg/I
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total Lo Lp
mgA
Orthophosphate
AI - Aluminum
_
mg/I
pH (when analyzed)
units
Ba = Barium
mg/I
mg/I
! / TOC 7 SD
rngn
Ca - Calcium
mg/I
Chloride
mgr
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
Phenol
mg/I
mg/I
Cu - Copper
Fe - Iron mg/I
Sulfate I D
m I/I
Hg - Mercury
mg/I
Specific Conductance (��'—uMhos
K - Potassiu EP. 3
mg/I
mg/I
Total Ammonia
mg/l
Mg - Magne um
mg/I
TKN as N
mg/I
Mn - Mango se
_-._....,.,-nrnmEwnmCo
_YES _ NO)
Ni - Nickel mg/I
Pb - Lean mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compoundsiation Units)
ORGANICS: (GC,GCIMS,HPLC) . -
(Specify test and method 9. Attach tab report.)
Report Attached? Yes (1) No _ (0)
VOID method It=
method a =
method M =
ulgea (m Authorized Agenq blame. and Title - Please print or type
',� &n r-bL
GW-59 Rev. 4198 gnahue aeqAA
o.

SUBMIT FORM ON YELLOW OW PAPER ONLY
ram'
G.
Clearly orType
Facility Name• Maxto 0
Permit Name (if different): '
Facility Addr2J1 N HcRair St
ess: i ? 0 Box 213
rilon t0ee0 14.C. 28364County - Scotland
tc'q Ralph C FidUas ' VO..Telephoneg:910/844/5279
Contact Person:
Well Location/ Site Name: Shaw Far No. of Wells to be Sampled:
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: q,' R ,Well Diameter. In. Check One:
Screened Interval: ft. to ft. ❑ influent (98)
Depth to Water Level:-ft. below measuring point ❑ Effluent (99).
Measuring Point is.—ft. above land surface. O
Galloons of water pumped/balled before sampling: Mhos
Refd analysis: pHJ.2 �o — . Specific Conductance u
o A l A
Temp "C Odor 0 0 Appearance
II t d unfiltered YES NO
PERMIT tl EXPIRATION DATE -
Non -Discharge 13878 UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Feld Remedialion:
Rotary Distributor Land Application of Sludge
Olfier:
.y
NOTE: Values should reflect dissolved and Ch
colloidal concentrations. e V
Date sample coil led: Date sample analyzed:--�
LaboratoryName Oxford ord Lab /
Certification No.I / 1 q /
and field acidified _YES _ NO)
PARAMETERS, (Samples for metals were co cc a
mg/I
Nitrite (NO2) as N
mg/(
COD
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
Phosphorus: Total as P
mg/I
mg/I
CDliform: MF Total /l ooml
ale
mg/l
,(Note: Use MPN method for highly turbid eamplest
Dissolved Solids: Total �', m9A
—units
At -Aluminum
At - Aluminum
mg/I
mg(
pH (when analyzed)
I mgll
Ba - Barium
Ca - Calcium
mg/I
TOC i
Chloride mgll
mg/I
Cd - Cadmium
Chromium: Total
mg/I
mg/I
Arsenic
mgll
Cu - Copp
mg/I
Grease and Oils
mg/I
Fe - Iron
mg/I
Phenol -
Sulfate mg/I
Merc
Hg - y
m /I
g
mg/I
S�D whos
Specific Conductance- —
K - Potass( m
mg/I
m ll
Total Ammonia mg/I
Mg - Magn slum
Mn - Mang FAYr VILLEREGIONALORRCE
mg/(
TKN as N
Ni - Nickel
Pb - Learl
Zn - Zinc
Ammonia Nitrogen�q'
Other (specify Compoun o l�eatfor
mg/1
mg/I
mg/I
mg/l
Units)
ORGANICS: (GC,GCIMS,HPLC) .
(Specify test and method N. Attach. lab report.)
ReportAttached? Yes_(1) No —(0)
VOC method If =
method It =
method N =.