WQ0018708_GW Monitoring_20091221

Q
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDVI/ATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFDRMATION Please Print Clearly or Type
Facility Name: V —/-,c f- /4 /C*S
Permit Name (if dlffere t):
Facility Address: ___ 3.3 t✓ 13 - - - ire,, -T e
Contact Person: S
Well Location/ Site
County - /4 -d-^ —
Telephone #:3—A0AW—
No. of Wells to be Sampled:
Well Identification Number (from Permit'-* G-e
Z
Y L/3Z
Well Depth: 2 �: 3 For Groundwater Treatment Systems
P ft. Well Diameter: — in. Check One; ❑ Influent (98)
Screened Interval: It, to ft.
Depth to Water Levu f . below measuring point. 13 Effluent (99)
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation ' ft.:
Gallons of water pump` d/bailed before sampling: /v- 6 r Date sample coliced: / / %o
Field analysis: pH 7 Specific Conductance uMho
Temp. `/ . % -C, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER'
PERMIT #: EXPIRATION DATE:
Non -Discharge L— d,s1 j- $- UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
S Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other: ` _
NOTE, Values should reflect dissolved and .
colloidal concentrations.
Date sample analyzed: _ //• / S'• 09
Laboratory Name:A"%ot- /g s
Certification No. �-
PARAMETERS (Samples for metals were collected unfiltered YES
COD
NO and field acidified
Coliform: MF Fecal < ►
Coliform: MF Total
mg/I
/100ml
Nitrite (NO2) as N
Nitrate (NO3) as N
ci /l
< Z mgg/l
(Note: Use MPN method for highly turbid samples)
Dissolved
/100ml
Phosphorus: Total as P
Orthophosphate
mg/I
m/I
Solids: Total C Yo.
pH (when analyzed)_--,mg/I
mg/I
Al - Aluminum
g
TOC
units
m9/I
Ba -Barium
Ca -Calcium
mg/I.
mg/I
Chloride %
---
Arsenic
mg/l
Cd - Cadmium
mg/I
Grease and Oils
mg/I
mg/I
Chromium: Total
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
mg/I
Sulfate
pecific Conductance
Total
mg/I
uMhos
Hg - Mercury
K - Potassium
mg/I
mg/I
Ammonia
TKN as N
mg/I
Mg -Magnesium
mg/I
ti
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
A
P '
ORGANICS: (;�q;/irl�,kii?9 fin!
(Specify test and methad'V.!�1Tch lab report.)
ROC tt attached? Yes (1) No (0)
method # =
method # =
method#=
certify that, to thA best of mu knnudoNnc
--
G W59
,-. ,.-.• •� .«� . yc. n�■on:a rims I:oe • r:ease print or type

GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION
Facility Name:
-�--�—�
Permit Name (if differe td ):
Facility Address: —_ 1.3
SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
Icy) County
Contact Person: S44*^- (zip) Telephone #: ��•�� `/
Well Location/ Site Name: 4a 2 No. of Wells to be Sampled: Ld
FRM Permit)
Well Identification Number (from Permit): 2 For Groundwater Treatment Systems
Well Depth: 2 Sr- d Z ft. Well Diameter: in.
Screened Interval: ft. to ft.Check One: ❑ influent (98)
Depth to Water Level: 2 ❑ Effluent (99)
�• S ff. below measuring point.
Measuring Point (M.P.) iss ft, above land surface. Relative M.P. Elevation in ft.: _
Gallons of water pumped/bailed before sampling: _ 1y o Date sample collected:
Field analysis: pH_ ('/-_- , Specific Conductance uMhos
Temp. 2Aff—OC, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE:
Non -Discharge WQ 0o 1 1f 7v $ UIC
NPDES
TYPE OF PERMLT OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other: _ -
NOTE: Values should reflect dissolved and
colloidal concentrations.
os Date sample analyzed: 9 ) ; 3- c ?
Laboratory Name: _ 4i 4,v, UC­
Certification No. ­ 1 Z
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N a. Z o mg /I
Coliform: MF Fecal / /100ml Nitrate (NO3) as N -e0 2 m/I
Coliform: MF Total M nn. rnl oti,.�.,t,........ -r-& t _- M e _ g .
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total C YO mg/I
PH TOC hen analyzed) / c, units
mg/I
Chloride ' mg/I
Arsenic mg/I
G
Orthophosphate ^ ^
mg/I
9
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
YES NO)
Ni - Nickel
mg/I
Pb - Lead
mg/I
Zn - Zinc
mg/I
Ammonia Nitrogen
mg/1
Other (Specify Compounds and C_o ce
- - _e�,
l Units)
P _
,ease and 011s
Phenol
mg/I
Cu - Copper
mg/I
4r:forrnation Processing Unit
Sulfate
mg/I
Fe - Iron
mg/I
ORGANICS: (GC,GC/MS,HPLC)OG
Specific Conductance
mgll
uMhos
Hg - Mercury
K - Potassium
mg/I
mg/l
(Specify test and method #. Attach lab report.)
Report Attached?
Total Ammonia
mg/I
Mg - Magnesium
mg/I
Yes (1) No (0)
VOC #
a TKN as N
mg/I
Mn - Manganese
mg/l
method
method #
method # _
or type
GW-59

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: - % A V % �c c /4 /C.S'
Permit Name (if differe t
Facility Address:--- 3 3 41. )3A./ i
_ icily)
lcnrt 1 YYVy
� County---��la
Cczv� —
dtr�
ontact Person:
Telephone#: `! Y3Z
Well Location/ Site Name: No, of Wells to be Sampled: Ly
(from Permlt
Well Identification Number (from Permlt): _ For Groundwater Treatment Systems
Well Depth: Z y ft, Well Diameter: in.
Screened Interval: it. to ft. Check One: ❑ Influent (98)
Depth to Water Level: 6 • `/ ftbelow measuring point. Effluent (99)
Measuring Point (M.P.) is: It. above land surface. Relative MY. Elevation in ft.: _
Gallons of water pumped/bailed before sampling: 1 is 2- Date sample collected:
Field analysis: pH S' 6 , Specific Conductance ' uMhos
Temp. Zo- 7 °C, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE:
Non -Discharge_ We ou,1 21� lv UIC
NPDES
TYPE OF PERM11-rED OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: .. _.Z )- -� .7- tx 9
Laboratory Name:yha— i
Certification No. J! 2-
PARAM ER (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N t o Z mg /i
Coliform: MF Fecal < / /100ml Nitrate (NO3) as N m/I
Coliform: MF Total /i norm Phnenhnrt tc• Tn+nl D "1 ..-9
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total _ '7 6
mg/I
pH (when analyzed)
units
�
TOCmg/I
Chloride 7• V
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
" TKN as N
mg/l
Orthophosphate
mg/I
AI - Aluminum
mg/I
Ba - Barium
mg/l.
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mall
YES NO)
Ni - Nickel
mg/1
Pb - Lead
mg/1
Zn - Zinc
mg/I
Ammonia Nitrogen
mg/I
Other (Specify C
'r
t)tion Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes —(I) No (0)
VOC method #
method #
G W-59

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Prinf Clearly or Type
Facility Name: 19,9 e
Permit Name (if different):
Facility Address:---?
3 >3 q �, r t e
(street) ---
lCny) Sfs •a►� ^.'sC- L YyZ,py County A�.-
Contact Person: `� ��^�•� Telephone #: g/v-Aw `/ y3z-
Well Location/ Site Name: No. of Wells to be Sampled: t-/
Well Identification Number (from Permit): _ A/ 5-Irom PermR)
Well Depth: Y. 3 For Groundwater Treatment Systems
P ft, Well Diameter: in. Check One: ❑ Influent (98)
Screened Interval:
Depth to Water Level: . 9 Z n, below measuring point. Effluent (99)
2
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/tiled before sampling: io. Z 2 Date sample collected:
Field analysis: pH !ss , Specific Conductance ' uMhos
Temp. / 9. `/ eC, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE: G-
Non -Discharge_ ovl ?o $ UIC
NPOES
T. YEE OF PERMITT n OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
Spray Field Remedialion:
Rotary Distributor Land Application of Sludge
Other:
NOTE.: Values should reflect dissolved and .
colloidal concentrations.
Date sample analyzed: 4
Laboratory Name:
Certification No. 9! �/ Z 2-
PARAMETERS (Samples for metals were collected unfiltered YES
COD
NO and field acidified
mg/I
/100ml
Nitrite (NO2) as N
Nitrate (NO3) as N
11,9 mg/I
'e• 0 z- mg/I
Coliform: MF Fecal G
Coliform: MF Total
/100ml
Phosphorus: Total as P__L.
s m /I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total -2 /
Orthophosphate
mg/I
PH analyzed)
mg/I
units
Al - Aluminum
Ba - Barium
mg/I
mg/I
TOCwhen
g
Chloride
mg/I
mg/l
Ca - Calcium
Cd - Cadmium
m9 /I
m /I
g
Arsenic
Grease and Oils
mg /I
Chromium: Total
m /I
g
Phenol
mg/I
mg/I
Cu -Copper
Fe - Iron
mg/I
mg/I
Sulfate
Specific Conductance
mg/I
uMhos
Hg - Mercury
K - Potassium
m /I
mg/I
Total Ammonia
TKN as N
mg/I
Mg - Magnesium
mg/I
mg/I
Mn - Manganese
mgll
(or
YES NO)
Ni - Nickel mg/1
Pb - Leant mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/1
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,G��fiSf'S "(r "„ e�sir,g Ut)lr
(Specify test and method #. Attach lab report.)
Report Attached? Yes —(I) No 0
VOC
method #
method # =
method # =
L./
G W-59
or

1 Enter date monitoring results were due. (' ) 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
IF 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.)? !l'thc: wisher is "Fes" contact the Regional Office•for guidance.
4 Are any monitored constituents equal to or above the established standards? YES N
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 constituents) 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?
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).
Are the monitoring wells listed in section 5 located at or beyond the review boundary? YES NO
.If the answer is "YES", a groundwater qualify 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 questlon ,7.is "NO", contact the Regional -Office within 90 da s• an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facilty. Failure to do so may sub
je
fines, and/or penalties. x ct the permittee to a Notice of Violation
lttfb _ .
m1<tlot7 ?009
g I The person completing this portion (GW-59A) Mihe 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 (Corn Hance Repo W-59A) is true and complete'to the best of my knowledge.
Signature of Permittee (or Authorized Agent) Date

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,;W,141 Nil r FURNI ON IL L.aW, PAPER ONLY
DEPARTMENT Or ENMONMENT �4 NATURAL Rr_s-ounm:s
Q�.PO UNIAN'ATF.P QUALITY MOITCH UKl: WATER OUALITY DNIMN, (3110UNIAVATER 8f.-,CTi0K
C_.(_)1VW1.JA,Nf.�E, PLPqPFopov1I6A'3L. MAIL, SUIVIC(9'-016T3G (Kati MC 9769 R
Phone: 919' 733-222,
-C r� C"ajv IT jr- nom Plea-
P E N10 IT V EXPIRATION OATE'.
Fn'� I N �i I Ti u,
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Naroo (if differn Non-Dischargo�
FacPitv 1"?: _�_c C,
TQC! 0PE.AATION BEING M0NFf-r)F E
t Catmly -
j 1-t-it nort infiltration Gcj�lary
Te!I%Mune
Y
wolf 1-orwition! Si?e woff�� t(v tn" f,'Ppray Fk�.,W edition:
Rotary t)jLfU!0fr 4and Application (if Sludq&
Wol) (frojil ':
4'r . For Grotimt,"71111 Tmatmt�li� "'Y�Imlls Otfle'
Wn1tDi'w11(Jfn': irl, (%I . 1, n . l' � Inf i 0 4� .� 0 (1 % ___ I I
KM"-, Vzilues should refled dissolvedand
colloid -al concentratimm
F"(11int 010,P) 11, nljovu L-110
gull!' Aemliv'� MT" t Jow-t-Q)n III It.,.
-illcm. 1.) tr:!d 1toloro - (A water put -Fir od/wa
0al6: f:ulloctod:
mto 0MJ)10 analyzed:
k'*j
j C" Odor
Geftit„ -.,-ilion Na.
ELU_-'1.(,(; fc�r wWnhs wore
collux ted unill tornd -XV.'s fi�:Id acidified
YES
(101)
as
r
mg,11
l'it"10
Fmal - - _' - -
_.' 0 rn I
IMI N, I N, (�l '9 i,'l
' " ' _' 3,
Pb -
CoWnran, MI Total
I 00'n I
Ph I wr nt- P g"/1
0 t' ho'
Zn - Zinc - -----
mg/1
rMolo. UL for!%IrJljy
ri�rng/1
Ammonia Nitrogen.—____—
rnqll
Di, 'olvod Suli&,: Toted, YY
Incill
Al - Afhan!ni im
rng/1
Oflie�,r (,Spocity Compounds and GonCentrotion Unit-S)
pH (vthan
Lip - rkghun
n )q/1
TOG __ -
.-1 1�
('- -11
�"t calcitui -,-.
11 -Ig/i
(w'd - Cadmium-
Am.cmiu
Chrowltwo: Tu, a!
mg/1
Gre',v'o ond MI.,;
rng/1
Fi- lrr)n,- rng/1
ORGANICS: (GC,G0/N18,f-lPL.q
f
(Specify lost and method A Attach
Igb r poi!.)
�s P e ("i tic, G'ond umfimn rl(,�.
C
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alg/l
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11�.N i,; I
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PAII M'Imj;'nwt,
(F;pe(-Xy ioq: and mcHmd 4 Mmh W
ReporMlached? Yos,_— -(1) No (0)
V X-I,
(AW ;pi
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lbacc 4
I A

C\V_:�;13A Cc3,11;'i.i:` NCI.: iZV110 T 11,011UVI Permit
I,Submit wic eua h uuautnrhn,, period ;eeli (r rf -i+/ fNr!n%.!
j
Enter date monitoring results were due. ( • 3 L_ ) 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 I 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.)? Ifthe answer is ")es". contact ►lie Regional Officefa•grddance.
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 4 is "YES" list the affected wells individually with constituent(s) and concentrations)
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?
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,, concentrations) reported, and sample collection date for each occurrence (for the last two years).
.
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 Regional Office within 90 days; an evaluation maybe
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.
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 m-=this
:report :(Compliance Re rfGW-59A) is.true:and complete to the tiest'of my knowledge.
Signature of Permittee (or Authorized Agent) Date
G% -59A 12!S/2003

SUBMIT FORM ON YELLYELLOYV PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: _-�PAx 7-l4P-c. /4Ae .5
Permit Name (if different).
Facility 9 dress:- 3 3 4i. �Ba y?, ' 12
l-!/M(h / t (sireeq .tom a Layi e/
(CuY) (Slain) (LP1 COtJnty
Contact Person: ' w ti`s Telephone #:
Well Location/ Site Name: x No. of Wells to be Sampled:: !!__..
Well Identification Number (from Permit): _f- For<Groundwater Treatment Systems
Well Depth: Zy S"d it. Well Diameter: � in. Chec'rbne: ❑ Influent (98)
Screened Interval: ft. to ft. " M Effluent (99)
Depth to Water Level: 7 0 r ft. below measuring point.
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation C
Gallons of water pumped ailed before sampling: /v• y y Date sample collectejr- z T, +4
Field analysis: pH , Specific Conductance uMhos i
Temp. / y Y °C, Odor Appearance t
DEPARTMENT OF ENVIRONMENT 6 NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
'PERMIT #: EXPIRATION DATE: 3 G
Non -Discharge to,�_ci DofY 70 8` UIC
NPDES
TYPE OOPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
spray Field Remediation:
Rotary Distributor. Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
(Date sample analyzed:
Laboratory Name:
Certification No. Xt.
PARAMETERS (Samples for metals were collected unfiltered YES "'N-NO
and field acidified
COD
mg/I
Nitrite (NO2) as N ' "
mg/I
Coliform: MF Fecal r
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
s mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total L/ Z
mg/I
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC _ t. 9 2
mg/I
Ca - Calcium
mg/I
Chloride 5s. 1
mg/l
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/l
Total Ammonia
mg/I
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
q?
• Z ice• a 911 REGENED
r
YES
lM
Ni - Nickel mg/I
Pb - Lead mg/I
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
ORGANf ,
(Specify test awd(ftl
Report Attached?
VOC
ttiod' Attach lab report.)
Yes (1) No (0)
method # =
method #
: method #

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please
Facility Name:- A) Tt`e- le& S
Permit Name (if different).
Clearly or Type
County
(City) (S,ala) (ZIP)
Contact Person:lAw --��s Telephone #: 9t" 3r8` (VIZ
Well Location/ Site Name: 1-. f/ No. of Wells to be Sampled:
(from Permit
Well Identification Number (from Permit): t% For Groundwater Treatment Systems
Well Depth: 2 -tr. 5 ft. Well Diameter: in. Check 0ne: ❑ Influent (98)
Screened Interval: ft. to it. ❑ Effluent (99)
Depth to Water Level: ft. below measuring point.
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/flailed before sampling: 4 9 tr Date sample collected: J? •L
Field analysis: pH A-1• , Specific Conductance ' uMhos
Temp. `3Z OC, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE: 3 %'
Non -Discharge td 5? ov tY ?0 $' UIC
NPDES
TYPE OF PERMIT7ED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NQTF: Values should reflect dissolved and
colloidal concentrations.
Date sample analyzed: 3.2 s'• o S
Laboratory Name: 1/46-1 n-
Certification No. ZL *� Y' 6 7
PARAMETERS (Samples for metals were collected unfiltered YES NO
and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal 4 /
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
o r mg/I
(Note: Use MPN method for highly turbid sam fes)
Orthophosphate
mg/I
Dissolved Solids: Total �-/
mg/l
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC �?, 71,
mg/1
Ca - Calcium
mg/I
Chloride G. Z
mg/l
Cd - Cadmium
mg/l
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/l
YES NO)
Ni - Nickel
mg/1
Pb - Lear
mg/I
Zn - Zinc -
mg/1
Ammonia Nitrogen
mg/I
Other (Specify Compounds and Concentration Units)
Phenol
mg/I
Fe - iron
mg/I
ORGANICS: (GC,GC/MS,HPLC)
Sulfate
mg/I
Hg - Mercury
mg/i
(Specify test and method #. Attach lab report.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia L . 2y
mg/I
Mg - Magnesium
-mg/I
VOC method # =
TKN as N
mg/I
Mn - Manganese
mg/i
method # =
Y
method #
GW-59 . , .

GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name:A
Permit Name (if different).'
SUBMIT FORM ON Y LL W PAPER ONLY
Please Print Clearly or Type
ke S
areer s!
an County
CodL
ntact Person: �t' rTJ 2"a"1 s �z�c� Telephone #: 914" - ��
Well Location/ Site Name: No. of Wells to be Sampled:
Well Identification Number (from Permit): 03 For Groundwater Treatment Systems
Well Depth: Z a . 7 It. Well Diameter., --I— in. Check 0ne: ❑ Influent (98)
Screened Interval: ft. to ft. ❑ Effluent (99)
Depth to Water Level: G- 21— ft. below measuring point.
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/bailed before sampling: la. 9"'S' Date sample collected: ?• e J -9
Field analysis: pH. 'L/- 2 , Specific Conductance uMhos
Temp. , 9 5— °C, Odor Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE: 3 s
Non -Discharge OotV 20 8' UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
MOTE: Values should reflect dissolved and .
colloidal concentrations.
Date sample analyzed: 3 • Z 5- 0 9
Laboratory Name: (Z e— 14
Certification No. J- ' 7 i , G 7
PARAMETERS (Samples for metals were collected unfiltered YES
NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal 41
/100ml
Nitrate (NO3) as N
s mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
L, o s'" mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total 92 mg/I
Al - Aluminum
mg/I
pH (when analyzed)
units
Ba - Barium
mg/I
TOC 3.2 Y
mg/I
Ca - Calcium
mg/I
Chloride 7.
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and -Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
Sulfate
mg/l
Hg - Mercury
mg/l
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia L2
mg/l
Mg - Magnesium
mg/I
TKN as N
mg/I
Mn - Manganese
mg/I
YES
NO)
Ni - Nickel mg/I
Pb - Lead mg/l
Zn - Zinc mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1 } No (0)
VOC method # =
method # =
method #
GW-59 n. __...._ ­_..__ • . .

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Prlrtt Clearly or Type
Facility Name:— '�a'Q X e-#_
Permit Name (if different).
Facility 9ddress: 3 3 4.• Y34?���
4-&66 4 `[ ISveeq
t nee L3YY -/County e3/�
Ply) - s /t �N (State) (Zip)
Contact Person: ! d 7'0..es Telephone #:
Well Location/ Site Name: Ae:�e b( x No. of Wells to be Sampled: !
Well Identification Number (from Permit): S­ For Groundwater Treatment Systems
Well Depth: 21s• Y6 ft. Well Diameter- in. Check 0ne: ❑ Influent (98)
Screened Interval: ft. to - ft. C] Effluent (99)
Depth to Water Level: IIC7 ft. below measuring point.
Measuring Point (M.P.) is: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped/balled before sampling: o Date sample collected: 3-1- 1-- -P
Field analysis: pH r , Specific Conductance uMhos
Temp, / eC, Odor. Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVISION, GROUNDWATER. SECTION
1636 MAIL SERVICE CENTER
PERMIT #, EXPIRATION DATE: f 3 I-t"t
Non -Discharge W ®otY 70 !r UIC
NPDES
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
spray Field Remediallon:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and .
colloidal concentrations.
Date sample analyzed: 3. 2 5"• d S
Laboratory Name: 1144 i
Certification No. ZL ? K 67
PARAMETERS- (Samples for metals were collected unfiltered YES NO and field acidified
COD mg/I Nitrite (NO2) as N mg/1
Coliform: MF Fecal / /100ml Nitrate (NO3) as N �• s" mg/I
Coliform: MF Total /100ml PhosDhorus: Total as mall
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 70 mg/l
pH (when analyzed)
units
TOC
L� /0 mg/1
Chloride 1 a. 2
mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
uMhos
Total Ammonia Z 8�
mg/I
TKN as N
mg/I
Orthophosphate
mg/I
Al - 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/l
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel
mg/I
Pb - Lead
mg/I
Zn - Zinc
mg/I
Ammonia Nitrogen
mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC method # =
method # =
method 4 =

-:'y HZ: I s'c°er,iii.
4 _
1
Enter date monitoring results were due.( •.3d•o ) 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
IF the answer to question 1 or 2 is "YES'; •list in the space provided below the well identification numbers) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of relmir or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? jf'the answer is 1'es ". contuc•r the /legioned Q%/ice,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 8.
If the answer to question 4 is "YES" list'the affected wells individually with constituents) 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?
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, concentrations) reported, and sample collection date for each .occurrence (for the last two years).
i.
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 subject the permittee to a Notice of Violation
I
fines, andlor penalties.
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 Re rt GW-59A) is true and complete -'to the' best of my knowledge.
Signature of'Permittee (or Authorized Agent) Date
(A\-�,!)\ 1'? :Sr20t13

4PR
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QWQ $CpGSing Ur,i�
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