WQ0000795_Monitoring - 11-2016_20161220 (5)

SUBMIT FORM ON YELLOW PAPER ONLY
MONITORING -
Name: Surf City W.W.T.P:
Name (if different):
Address: P.O. Box 2475
ly (Street) NC 28445 Onslow
_ County
act'Person: Steve Smith Telephone#: [phone]
Location/Site Name: Zone H No_ of wells to be sampled: 1
from Permit
) L
PILING INFORMATION - _ -
L ID NUMBER (from Permit): MW -9 Date sample collected: 11110/16.
Depth: 12 ft_ Well Diameter 2 in.
h to Water Level 82546: 4.7 ft. below measuring point Screened Interval: 2 ft. to 12 ft.
curing Point is 2:5 _ft. above land surface. Relative M.P. Elevation: ft.
of water pumped/bailed before sampling: 5gallons
t for metals were collected unfiltered: ❑ YES ❑ NO
ATMENT OF ENVIRONMENT & NATURAL RESOURCES
ION OF WATER QUALITY4NFORMATiON PROCESSING UNIT
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone; i
.GAIT Number: WQ0000795 Expiration Date: 1-31
-Discharge UIC
,ES Other
`PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
X $pray Field ❑ Remediation:
Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other.
FIELD ANALYSES:
WAS
pH oo400: 4.66 units Temp. 000io: 19 °C
DRY at
Spec. Cond. 00094: µMhos
time li
*int/PiC ?EQIC
samplir
Odor 00085: none
check
Appearance clear/mild turb
here -j—
ite sample analyzed: see report
Laboratory Name: Envirochem
pH (Lab) 00403
Certification No. 94
11AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
mg/L
*int/PiC ?EQIC
COD 00335
mg/L Nitrite (NO2) as N oo615 <.02
mg/L
Pb - Lead wom ug/L
Coliform: MF Fecal 31616 <1
/100mL Nitrate (NO3) as N 00620 <.02
mg/L
Zn - Zinc olo92 mg/L DEC.2 0 7016
Coliform: MF Total 31504 - _
/100mL Phosphorus: Total as'P 00665-21
mg/L
- -
(Note: Use MPNmethod for highly furbidsamples)
Orth h h t
/L
nth S C d d'C M I CllardA
Ived Solids:Total 70300 300
mg/L
pH (Lab) 00403
units
TOC oo68o 6.3'
mg/L
Chloride oo94o 133
mg/L
Arsenic oloo2
ug/L
Grease and Oils oo552 _
mg/L
Phenol 32730
ug/L
Sulfate 00945
mg/L
is Conductance 00095
µMhos
Total Ammonia oo610 <.2
mg/L
(Ammonia Nitrogen; NH3 asN; Amrrwnia Nitrogen; Total)
mg/L
TKN as N 00625
mg/L
For Remediation Systems Only (Attach Lab Reports):
op osp a e 7.807 mg ,
AI -Aluminum oil o5 mg/L
Ba - Barium oioo7
ug/L
CA _ Calcium oog16
mg/L-
Cd - Cadmium 01027
ug/L
Chromium: Total 01034
ug/L
Cu - Copper 0io4z
mg/L
Fe - Iron olo45
ug/L
Hg - Mercury 71900
ug/L
K - Potassium oo937 _
mg/L
Mg - Magnesium oo927
mg/L
Mn - Manganese oio55
ug/L
Ni - Nickel oio67
ug/L
Influent Total VOCs:
.1 (, peclfy ompoun s an oncentra lon v1111t1;A s
A penjitingUnit
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOG 78732; method #
method# _
method #
method
ma/L Effluent Total VOCs:
ma/L VOC Removal%
GW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
TER QUALITY MONITORING:
E REPORT FORM
ACILITY INFORMATION Please Print Clearly or Type
=acility Name: Surf City W.W.T.P.
'ermit Name (if different):
acilityAddress: 'P.O. Box 24.75
Surf City (street) NC 28445 County Onslow
act Person: Steven Smith Telephone* 910-233-5169
Location/Site Name: zone D No. of wells to be sampled: 1
PARTMENT OF ENVIRONMENT & NATURAL RESOURCES
1SION OF WATER QUALITY -INFORMATION PROCESSING UNIT
7 MAILSERVICECENTER, RALEtGFI, NC 27699-1617 Phone: [phone]
IRMiT Number: WQ0000795 Expiration Date: 1-31-17
n -Discharge UIC
'DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field 0 Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other.
WELL ID NUMBER (from Permit): MW -10
Date sample collected: 11/10/16
Chloride 0094o 54
FIELD ANALYSES:
WAS'.
Well Depth: 12 ft.
p
Well Diameter: 2 In.
mg/L
p 4.76 units Temp. 000lo 19.8 °C
H 00400:
DRY at
Depth to Water Level 2546: 6.4 ft. below measuring point Screened Interval: 2 ft,
to 12 ft:
Spec. Cond. 00094° µMhos
time of
sampling;
Measuring Point is 2.5 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 000s5: none
check
Volume of water pumped/bailed before sampling: 5
gallons
Appearance clearlmild turb
here:
Samples for metals were collected unfiltered; ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
_
LABORATORY INFORMATION
_
Date sample analyzed: see report
Laboratory Name: Envirochem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 <.02
mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 s1 /100mL
Nitrate (NO3) as N 00620 <,02
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 1100mL
Phosphorus: Total as P owes ,08
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate n5o7
mg/L
Other (Specify Compounds and Concentration Units):
Nssolved Solids:Total 70300 127 mg/L
AI -Aluminum o11o5
mg/L
pH (Lab) oo403 _ units
Ba - Barium oioo7
ug/L
TOC ooaao .9
mg/L
Chloride 0094o 54
mg/L
Arsenic 01002
ug/L,
Grease and Oils 00552
mg/L
Phenol 32730
ug/L
Sulfate 00945
mg/L,
Ific Conductance o0095.
µMhos
Total Ammonia oomo <2
mg/L
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
ug/L
TKN as N 00625
mg/L
For Remediation Systems Only (Attach Lab Reports):
Ca - Calcium oo916
mg/L
Cd - Cadmium 01o27
ug/L
Chromium: Total 01034,
ug/L
Cu - Copper 01042
mg/L
Fe - Iron o1045
ug/L
Hg - Mercury 71900
ug/L
K - Potassium oo937
mg/L
Mg - Magnesium oo927
mg/L
Mn -Manganese o1055
ug/L
Ni - Nickel olo67
ug/L
Influent Total VOCs:
iiC f' 0 A na+�
ORGANICS: (by GC, GCLMS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: method #
method #
method #
method #
Effluent Total VOCs
mg/L VOC
��. y v
Steven Smith 12/12/16
Permittee (or Authorized Agent) Name and, Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW -59 Rev. 2/2010

SUBMIT
TER QUALITY MONITORING:
E REPORT FORM
ratteATlnnt Please
=acility Name: Surf City W.W.T.P.
'ermit Name (if different):
=acility Address: P -O. Bax 2475
Surf City. (Street) NC 28445' Onslow
_ County
act Person: Steven Smith Telephone#: [phone]
Location/Site Name: Zone C No- of wells to be sampled: 1
PAPER ONLY
LENT OF ENVIRONMENT & NATURAL RESOURCES
OF WATER QUALITY -INFORMATION PROCESSING UNIT
SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: I
Number: Expiration Date: 1-31-1
charge W0000795 - UIC
'DES Other
RE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:
El Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
LID NUMBER (from Permit): MW -11 Date sample collected: 11/10/16 FIELD ANALYSES: IWAS
Depth: 12 ft. Well Diameter: 2 in. pH ooioo: 4.8 units Temp. 000lo: 19.6 °C DRY at
i to Water Level 82546: 7-8 ft. below measuring point Screened Interval 2 ft. to 12 fl. Spec. Cond. 00094: µMhos time of
sampling_,
luring Point is 3 ft. above land surface Relative M.P. Elevation: _ _ ft. Odor 000m: none check
ne of water pumped/bailed before sampling: 5, gallons Appearance orange very'turb here:
-ilafi fnr matnbz wars- rtnllartad i unfilharad- n VFA 1-1 mr? nnri fialri �rimfi.,+ P-1 YFG F-1 mr)
Date sample analyzed: see report
Laboratory Name: Envirochem
pH (Lab) 00403
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
mg/L
Chloride o094o 21
COD 00335
mg/L Nitrite (NO,) as N 00615 .17
mg/L
Pb - Lead o165 ug/L
Coliform: MF Fecal 31616 <1
/100ml- Nitrate (NO3) as N 00620 <.02
mg/L
Zn - Zinc 09092 mg/L
Coliform: MF Total mm
/I GOmL Phosphorus: Total as P omm .58
mg/L
Total Ammonia oo610 1.2
(Nae: Use MPN method for highly tulf7id samples)
Orthophosphate 7o5o7
mg/L
Other (Specify Compoun"I Concentration Units):
)issolved SolidstTotal 7030o 391
mg/L
pH (Lab) 00403
units
TOC oo6ao 4-6
mg/L
Chloride o094o 21
mg/L
Arsenic oloo2
ug/L.
Grease and Oils 00552
mg/L
Phenol 32730
ug/L
Sulfate 00945
mg/L
3peeific Conductance o0o95
µMhos
Total Ammonia oo610 1.2
mg/L
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
ug/L
TKN as N oo625
mg/L
For Remediation Systems Only (Attach Lab Reports):
AI -Aluminum 61105
mg/L
Ba -'Barium o1oo7 _
ug/L
Ca - Calcium 00916
mg/L
Cd -Cadmium olo27
ug/L
Chromium: Total oto -34
ug/L
Cu - Copper 01042
mg/L
Fe - Iron o045
ug/L
Hg - Mercury 71900 _
ug/L
K - Potassium oo937
mg/L
Mg - Magnesium oo927
mg/L
Mn - Manganese o9om
ug/L
Ni - Nickel 01067
ug/L
Influent Total VOCs:
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Repdrt Attached? ❑ Yes (1) ❑ No (0).
VOC 78732: method #
method #
Effluent Total
, method #
method #
mg/L VOC Removal%
Steven Smith ORC ! v 12/12/1.6
print type Signature of Permittee (or Authorized' Agent) (Date)
Permittee (or Authorized Agent) Name and Title -Please not or
GW -59 Rev- 212010

SUBMIT FORM ON YELLOW PAPER ONLY
R QUALITY MONITORING:
REPORT FORM
:acility Name: Surf City W.W.T_P.
3ermit Name (if different):
acility Address: P -O. Box 2475
Surf City (s;—j) NC 28445 County Onslow
act Person: Steven Smith Telephone#: [phone]
Location/Site Name: Zone A No. of wells to be sampled: 1
L ID NUMBER (_from Permit): MW -12 Date sample collected: 11/10/16
Depth: 12 ft. Well Diameter: 2 in.
i to Water Level 82646:4.6 ft. below measuring point Screened Interval: 2 ft. to 12 %
Luring Point is 2.6 ft: above land surface Relative M.P. Elevation: ft.
of water pumped/bailed before sampling:
IENT OF ENVIRONMENT & NATURAL RESOURCES
OF WATERQUALITY-INFORMATION PROCESSING UNIT
SERVICE CENTER, RALEIGH; NC 27699-1617 Phone:[phone]
Number: WQ0000795 Expiration Date: 1-31-17
n -Discharge UIC_
'DES Other
PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation; Infiltration Gallery
Al Spray Field ❑ `Remediation:
Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES;
WAS
pH oo400: 5.07 units Temp. 000lo: 19.1 °C
DRY at
--
Spec. Cond. 00094: mhos
time
time of
Chloride oo94o 165
r
Odor 00065: mild sulfur
check
Appearance It tan/mild Curb
,here: '
tte sample analyzed: see report
Laboratory Name; Envirochem
pH (Lab) oo4o3
_ Certification No. 94
#RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
mg/L
Chloride oo94o 165
COD 00336
mg/L Nitrite (NO2)as N oo615 <.02
mg/L
Pb -Lead 01051. ug/L
Coliform: MF Fecal 31616 7
/100mL Nitrate (NO3) as N 00620 <.02
mg/L
Zn - Zinc 01094 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P oo6s5 -18
mg/L
Mn - Manganese 01055
(Note: Use WN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Cornpoun sal, Concentration Units):
Solids:Total 703oo 318
mg/L
pH (Lab) oo4o3
units
TOC 00680 9.9
mg/L
Chloride oo94o 165
-mg/L
Arsenic 01002
u91L
Grease and Oils 00552
AI -Aluminum o11o5
mg/L
Ba - Barium o1oo7
ug/L
Ca - Calcium 00916
mg/L
Cd - Cadmium olo27
ug/L
Chromium: Total o1o34
_ ug/L
mg/L Cu - Copper o1o42
mg/L
32730
/L
U /L
ug
Fe - Iron 01045,
ug/L
Sulfate oo945
mg/L
Hg - Mercury 71900
ug1L
ic Conductance 00095
pMhos
K - Potassium 00937
mg/L
Total Ammonia oo610 <2
mg/L
Mg - Magnesium 00927 -
_ mg/L.
(Ammonia Nitrogen. NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
TKN as N 00625 - mg/L
For Rernediation Svstems Only (Attach Lab Reports):,
�.
gin
-- DECs.- SV..IV
ORGANICS: (by GC, GC/MS; HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1_) ❑ No. (Q)
VOC 78732: method #
method # _
method #
Ni --Nickel 01067 - ug/L method #
Influent Total VOCs: mq/L Effluent Total VOCs mq/L VOC Removal%
Permittee (or Authorized Agent) Name and Title - Please print or type - Signature of Permittee (or Authorized Agent) (_Date)
GW -59 Rev. 212010

SUBMIT FORM ON YELLOW PAPER ONLY
TER QUALITY MONITORING:
E REPORT FORM
Name: Surf City W.W.T.P.
Name (if different):
Address: P.O. BOx 2475
{Street)
fy NC 28445 County Onslow
act Person- Steve Smith Telephone#. [phone]
Location/Site Name: 30 Acre Storage Pond No. of wells to be sampled: 1
from. Permit
PLING INFORMATION
LID NUMBER (_from Permit): PZ -13 Date sample collected: 11/10116.
Depth: 25 ft. Well Diameter: 2 in.
1 to Water Level 82546:16.3 ft. below measuring point Screened Interval: 10 ft. to 25
luring Point is 2 ft. above land surface Relative M.P. Elevation: ft.
ne of waterpumped/bailed before sampling: gallons
El YES El
TENT OF ENVIRONMENT & NATURAL RESOURCES
OF WATER QUALITY -INFORMATION PROCESSING UNIT
-SERVICE CENTER; RALEIGH, NC 27699-1617 Phone: [phone]
Number: Expiration Date: 1-31-17
:harge W00000795 UIC
'DES Other
`PE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
ON Spray Field ❑ Remediation:
❑ Rotary Distributor C❑ Land Application of Sludge
Water Source Heat Pump ❑ Other.
FIELD ANALYSES: WAS
pH ooaoo: I units Temp. 000lo: °C DRY at
ft.Spec. Cond. 00094: µMhos time ofsamplir
Odor 00085: _ check
Appearance here: r
Ite sample analyzed:
Laboratory Name: Envirochem
pH (Lab) 00403
Certification No. 94
kRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
mg/L
Chloride 00940
COD 00335
mg/L Nitrite (NO2) as N oo615
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616
/100mL Nitrate (NO3) as N 00620
rrig/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P oo6s5
mg/L
Total Ammonia 00610
(Note: Use MPN method for highly turVid samples)
Ortho 1105 hafe 7Q507
mg/L
Other (S ecify Com ounds and Concentration Units)*
Ived Solids:Total 70300
mg/L
pH (Lab) 00403
units
TOC oo68o
mg/L
Chloride 00940
mg/L
Arsenic 01002
ug/L
Grease and Oils 00552
mg/L
Phenol 82730
ug/L
Sulfate oo945
mg/L
ific Conductance 00095
µMhos
Total Ammonia 00610
mg/L
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) -
TKN as. N 00$25 mg/L
For Remediation Systems Only (Attach Lab Reports):
Steven Smith ORC-
Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010
F p
-
AI - Aluminum o11o5
mg/L
Ba - Barium o3oo7
ug/L
Ca - Calcium 0osl6
mg/L
Cd - Cadmium o1o27
ug/L
Chromium: Total o1o34
ug/L
Cu - Copper 01042
mg/L
Fe - Iron 0-1045
ug/L
Hg - Mercury 71900
ug/L
K - Potassium oo937
mg/L
Mg - Magnesium 00927
mg/L
Mn - Manganese 01055
ug/L
Ni - Nickel 01067
ug/L
p p _
npr 9. {� ?nIG,
ORGANICS.: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: method #'
method #
method #
method #
Influent Total VOCs: mg/L Effluent Total VOCs:
VOC Removal°

SUBMIT FORM ON YELLOW PAPER ONLY
=_R QUALITY MONITORING_ :
REPORT FORM
ll®TIntJ Please
Facility Name: Surf City W_W T.P_
Permit Name (if different): _
Facility Address: P•O. BOx 247,5
Surf City (street) NC 28445 County Onslow
act Person: Steve Smith Telephone#: [phone]
Location/Site Name: 30 Acre Storage Pond No. of wells to be sampled: I
L ID NUMBER (from Permit): PZ -14 Date sample collected: 11/10116
Depth: 20 ft Well Diameter: 2 in.
h to Water Level 82546: 16.8 ft. below measuring point Screened Interval: 10 ft. to 25 ft_
curing Point is 2 ft. above land surface Relative M.P. Elevation: ft_
ne of water pumped/bailed before sampling: _.. _ gallons.
nsioN QF WATER QUALITY-INFORMAMON PROCESSING UNIT
17 MAIL SERVICE CEWER, RALEIGH, NC 27699.1617 Phone: [phone]
-RMIT Number: Expiration Date: 1-31-17
m -Discharge WQ0000795 UIC
'DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ ,Remediation: Infiltration .Gallery
IN Spray Field ❑ Remediation:
Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES: WAS
pH ooeto0: units Temp. 000lo: °C DRY at
Spec. Cond. 00094: µMhos time of
- - - - samplin
Odor 00085: check
Appearance here: r
ite sample analyzed:
Laboratory Name: Envirochem
'TOC 00680
Certification No. 94
\RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
mg/L
Arsenic oloo2
COD 00335
mg/L Nitrite (NO2) as N oos15
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616
/10QmL Nitrate (NO3) as N 00620
mg/L
Zn - Zinc o1os2. mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P 00665
mg/L
(Ammonia Nitrogen; NH3as N; Ammopia Nitrogen, Total)
(Note: use MPN method for highly turbid samples) —
Ortho hos hate 7-0507
m /L
Other (Secify Co u s and Concentration Units):
Solids:Total 70300
mg/L
pH (Lab) oo4m
units
'TOC 00680
mg/L.
Chloride 00940
mg/L
Arsenic oloo2
ug/L
Grease and Oils 00552
mg/L
Phenol 32730
ugll-
Sulfate 00945
mg/L
fic Conductance 00095
iMhos
Total Ammonia oo610
mg/L
(Ammonia Nitrogen; NH3as N; Ammopia Nitrogen, Total)
mg/L
TKN as N oos25
mg/L
For Remediation Systems Only (Attach Lab Reports):
Steven Smith OR
Permittee (or Authorized Agent) Name and Title - Please print or type
GIN -59 Rev. 2/2010
p p
- - - - g.
AI' -Aluminum o11o5
mg/L
Ba - Barium 01007
ug/L
Ca - Calcium 00916
mg/L
Cd = Cadmium 01027
ug/L
Chromium: Total o1o34
ug/L
Cu - Copper 01042
mg/L.
Fe - Iron dio4s
ug/L
Hg - Mercury 71900
ug/L
K - Potassium oo937
mg/L
Mg - Magnesium oo927
mg/L
Mn -- Manganese o1o56
ug/L
Ni - Nickel o1o67
ug/L
Influent Total. VOCs:
UEt, Lu
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab ReportAttached? ❑ Yes (1) ❑ No (0)
VOC 78732: method #
method #
Effluent Total VOCs:
, method #
, method #
VOC Removal%o

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM_ _
cArn iry 11k1rnoutArPrnu Please Print Clearly or
Facility Name: Surf City W.W.T.P.
Permit Flame (if different):
Facility Address: P.O. BOx 2475
Surf Ci '6tren" NC 28445
City County Onslow
act Person: Steve Smith Telephone#: [phone]
Location/Site Name: 30 Acre Storage Pond No. of wells to be sampled: 1
LID NUMBER (from Permit): PZ -15 Date sample collected: 11110/16
Depth: 25 ft. Well Diameter: 2 in.
i to Water Level 82546:15-3 _ ft. below measuring point Screened Interval: 10 ft. to 25 ft.
luring Point is 2 ft. above land surface Relative M.P. Elevation: ft.
of water pumped/bailed before sampling: - gall
> for metals were collected unfiltered: 0 YES ❑ NO
'ARTMENT OF ENVIRONMENT & NATURAL RESOURCES
ISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
7 MAIL SERVICE CENTER, RALEIGH, NC 27699-161.7 Phone: [phone]
RMIT Number: Expiration Date: 1-31-17
n -Discharge WQ0000795 UIC
DES Other
PE OF PERMITTED OPERATION BEING MONITORED
Lagoon 0 Remediation: Infiltration Gallery
0■ Spray Field 0 Remediation:
0 Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
FIELD ANALYSES: WAS
pH 00400:_ units Temp. 000lo: °C DRY at
Spec. Cond. 00064: µMhos time ofsampling_,
Odor 000m: check
Appearance _ here:
Ite sample analyzed: _ Laboratory Name: Envirochem Certification No. 94
\RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L. Nitrite (NO,) as N oasis mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /1 OOmL Nitrate (NO.) as N om2o mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/1 OOml-
Phosphorus: Total as P 00665
mg/L
(Note: use MPN method for highry turbid samples)--
Orthophosphate 70507
mg/L
solved SolidsTotal 70300
mg/L
AI - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium o1oo7
ug/L
TOC oomo
mg/L
Ca -Calcium 00916
mg/L
Chloride 00940
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total o1om
ug/L
Grease and Oils 00652
mg/L
Cu - Copper 01042
mg/L
Phenol 32730
ug/L
Fe- Iron 01045
ug/L
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
acific Conductance 00095
µMhos
K - Potassium oo937
mg/L
Total Ammonia ooslo
mg/L
Mg - Magnesium oo927
mg/L
(Ammonia Nitrogen; NH, as N; Ammonia _Nitrogen, Total)
Mn - Manganese o1o55
_ ug/L
TKN as N 00625 mg/L
For Remediation Systems Only (Attach Lab Reports):
Other (Specify Com, pgurrds and Concentration Units):
btff 2 01 /06
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: , method #
method #
method #
Ni - Nickel 01067 _ ug/L method #
Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%o
Steven Smith ORC ✓ -t-u, � 12/12/16
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
=R QUALITY MONITORING:
REPORT FORM
=AGILITY INFORMATION Please PrintClearly or Type
acility Name: Surf City W.W.T.P,
3ermit Name (if different):
acility Address: P.O. BOx 2475
Surf City (street) NO 28445
County Onslow
(City) (State) (Z!p) --__-. -
act Person Steve Smith Telephone#: [phone]
Location/Site Name: 30 Acre Storage Pond No. of wells to be "sampled: 1
L IA NUMBER(fromPermit):: PZ -16
Depth: 25 ft.
to Water Level 82646:13.3 -ft. below measuring point
firing Point is 2 fit. above land surface
Date sample collected: 11/10116
Well Diameter: 2 in.
Screened Interval: 10 ft. to 25 ft.
Relative M.P. Elevation ft.
of water pumped/bailed before sampling: gallons
> for metals were collected unfiltered: ❑ YES ❑ NO
ite sample analyzed: .__
Laboratory Name: Envirochem
pH' (Lab) oo4o3
U2AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
TOC ow8o
COD 00336
mg/L Nitrite (NO.) as N oosls
mg/L
Coliform: MF Fecal 31616
/100mL Nitrate (NO3) as N 00620
mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P',00665
mg/L
(Note: use MPN method for )uglily tumid samples)
Orthophosphate 70507
mg/L
ved Solids:Total 70300
mg/L
pH' (Lab) oo4o3
units
TOC ow8o
_ mg/L
Chloride 00940
mg/L.
Arsenic 01002
ug/L
Grease. and Oils 00652
mg/L
Phenol 32730
ug/L
Sulfate 00945
mg/L
fic Conductance 00095
µMhos
Total Ammonia oos10
mg/L
(Ammonia Nidogen; NHeas N; Ammonia Nitrogen, Total)
ug/L
TKN as N 00,625
mg/L
For Remediation, Systems Only (Attach Lab Reports):
At - Aluminum 01105
. mg/L
Ba - Barium o1oo7
ug/L
Ca - Calcium 00916
mg/L
Cd - Cadmium o1o27
ug/L
Chromium: Total 01634
ug/L.
CU - Copper 01042
mg/L
Fe - Iron oio45
ug/L
Hg - Mercury 71900
-_ _ ug/L
K - Potassium oo937
mg/L
Mg - Magnesium oo927
mg/L
Mn- Manganese aims
ug/L
Ni - Nickel 01067
ug/L
Influent Total VOCs:
OF WATER QUALITY -INFORMATION PROCESSING UNIT
SERVICE CENTER, RALEIGH, NC 27699-1617 Phone- [phone]
'Number Expiration Date: 1-31-17
charge WQ0000795 UIC
Other
'PE OF PERMITTED OPERATION BEING • MONITORED
0 Lagoon ❑ Remediation: Infiltration Gallery
F01 Spray Field ❑ Remediation:
El Rotary Distributor El Land Application of Sludge
❑ Water Source Heat Pump ❑ Other;
FIELD ANALYSES: IWAS
PH p DRY' at
H 00400: units Tem 00010: C
Spec. Cond. 00094: µMhos time of
sampling,
Odor 000ms check
Appearance here: Q
Pb Lead 01051
Certification No. 94
ug/L
Zn - Zinc 01092 mg/L
Other (Specify CompoundsandConcentration Units):-
_
nor 9. A mr,
ORGANIC& (by GC, GC/MS, HPLC)
(Specify test and method #.. ATTACH LAB REPORT.)
Lab Report Attached? 0 Yes (1) 0 No (0)
VOC 78732: method #
method #
method #
method #
mg/L Effluent Total VOCs:
mg/L VOC Removal%
OW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
DWATER QUALITY MONITORING:
IANCE REPORT FORM
aciiity Name: Surf City W.W.T.P
?ermit Name (if different):
adlity Address: PO Sox 2475
Surf City (Street) NC 28445 County Onslow
act Person: Steve Smith Telephone#: 910-233=5169
Location/Site Name, Zone 4 No. of wells to be sampled: 1
.L ID NUMBER (from Permit) Well 3 Date sample collected: 1.1/90116
Depth: 18.2 ft. Well Diameter: '2 in.
h to Water Level 82546: 6.2 ft. below measuring point Screened Interval: 17 ft, to 18.2 ft:
luring Point is 3.4 ft above land surface Relative M.P. Elevation: ft.
Tie of water pumped/bailed before sampling: 5.0 gallons
Dies for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: 0 YES ❑ NO
OF WATER QUALITYaNFORmATION PROCESSING UNIT
- SERVICE CENTER, RALEIGH, NC 27689-1617 Phone:
er: Expiration Date:
wg0000795 OIC
'DES Other _
PE OF PERMITTED OPERATION BEING MONITORED
Lagoon ❑ Remediation: Infiltration Gallery
❑! Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
El Water Source Heat Pump ❑ Other.
FIELD ANALYSES:
Laboratory Name: Erivirochem
WAS.
PH oo400: 6.67 units Temp. 000to: 20.6 °G
kRAMETER_ S NOTE:' Values_ shouldreflect dissolved and colloidal concentrations.
DRY at
Spec. Cond. 00094: Fr Mhos
COD 00335
time of
samplir
Odor 00085: none _
Pb - Lead olo51 ug/L
check
Appearance Lt Tan
mg/L
here: F
Ste sample analyzed: see Report
Laboratory Name: Erivirochem
pH (Lab) 00403
Certification No. 94
kRAMETER_ S NOTE:' Values_ shouldreflect dissolved and colloidal concentrations.
mg/L
Chloride oo94o 19
COD 00335
mg/L Nitrite (NO2) as N 00615 t.02
mg/L
Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 4
1100ml- Nitrate (NO,) as N 00624 <.02
mg/L
Zn - Zinc o1o92 mg/L
Coliform: MF Total 31504
/100ml- Phosphorus; Total as P oos65 .47 _
mg/L
Total Ammonia 00610 <-2
(Note: Use.MPN method' for highly hubid.samples)
Orthophosphate 7050 _ .
mg/L
Other (Specify Compounds and Concentration Units):.
ved Solids:Total 7030o 138
mg/L
pH (Lab) 00403
units
TOC oo68o 20
mg/L
Chloride oo94o 19
mg/L
Arsenic oloo2
ug/L
Grease and Oils 00552
mg/L
Phenol 32730 -
ug/L
Sulfate 60945
mg/L
fic Conductance 00095
µMhos
Total Ammonia 00610 <-2
mg/L
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
uglL
TKN as N oo62s
mg/L
For Remediation Systems Only
Al - Aluminum oil o5
mg/L
Ba = Barium o1ow
ug/L
Ca - Calcium oo916
mg/L
Cd - Cadmium olo27
ug/L
Chromium- Total 01034
ug/L
Cu - Copper 01042
mg/L
Fe - Iron o1o4fi
ug/L
Hg - Mercury 71900
ug/L
K - Potassium oo937
mg/L
Mg - Magnesium 00927
mg/L
Mn- Manganese o1o55
uglL
Ni - Nickel oio67
ug/L
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: method #
method ,#
method `#
method' #
Reports).- Influent Total VOCs: mg/L Effluent Total VOCs:
mg/L VOC Removal%a
Steven Smith ORC;J " �� 12/12/16
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
TER QUALITY MONITORING:
E REPORT FORM
Facility Name: Surf City W.W.T.P
Permit Name (if different):
Facility Address: PO Box 2475
Stresti
Surf City NC 28445_ County Onslow
(CAY) (Stave) 0P,
act Person: Steve Smith Telephone#: [phone]
Location/Site Name: zone 1 No. of wells to be sampled: 1
from Permit)
PLING INFORMATION
L ID NUMBER (from Permit): Well 4 Date sample collected: 11/10/16
Depth: 1.8.4 ft. Well Diameter: 2 in.
Ito Water Level 82546:4-1 ft. below measuring point Screened Interval: 16.4 ft. to 18.4 ft.
luring Point is 2.2 ft. above land surface Relative M.P. Elevation: ft.
ne of water pumped/bailed before sampling 5-0 gallons
)les for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
LENT OF ENVIRONMENT & NATURAL RESOURCES
OF WATER QUALITY -INFORMATION PROCESSING UNIT
7 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
RMIT Number: Expiration Date: 1 -31-
n -Discharge Wg0000795 UIC
DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field El Remediation:
Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
ate sample analyzed: see report Laboratory Name: Envirochem Certification No. 94
kRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2.) as N 00615 <.02 mg/L Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N' 00620 <.02 mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 - /100mL Phosphorus: Total as P 00665 .08 mg/L
(Note: Use MPN method for highly turbid samples) - -
Solids:Total 703oo 474
If WELL
FIELD ANALYSES:
WAS
pH oo400: 6.02 units Temp. 000lo: 20-4 °C
DRY at
Spec. Cond. 00094: µMhos
time of
Total Ammonia oosio <.2
sampling,
Odor 0008$t none
check
Appearance It tan/turbid
here:
ate sample analyzed: see report Laboratory Name: Envirochem Certification No. 94
kRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2.) as N 00615 <.02 mg/L Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 <1 /100mL Nitrate (NO3) as N' 00620 <.02 mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 - /100mL Phosphorus: Total as P 00665 .08 mg/L
(Note: Use MPN method for highly turbid samples) - -
Solids:Total 703oo 474
mg/L
pH (Lab) oo4o3
units
TOC 0068o 4.9
mg/L
Chloride 00940 192
mg/L
Arsenic 01002
ug/L
Grease and Oils 00552
mg/L
Phenol 32730
u
Sulfate 00945
mg/L
ific Conductance 00095
µMhos
Total Ammonia oosio <.2
mg/L
(Ammonia Nitrogen; NF6as N; Ammonia Nitrogen, Total)
ug/L
TKN as N 00625 mg/L
For Remediation Systems Only (Attach Lab Reports):
Orthophosphate 70507
mg/L
Al - Aluminum oil os
mg/L
Ba - Barium 01007
u
Ca - Calcium oogi6
mg/L
Cd - Cadmium 01027
ug/L
Chromium: Total oio34
ug/L
Cu - Copper 01042
mg/L
Fe - Iron 01045
ug/L
Hg - Mercury 71900
ug/L
K - Potassium 00937
mg/L
Mg - Magnesium oogz7
mg/L
Mn - Manganese o1o55
ug/L
Ni - Nickel 01067
ug/L.
Influent Total VOCs:
Other (Specify Comp=d and Concentration Units):
OEC 2 u 2uf6
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: method #
method #
method #
method #
mg/L Effluent Total VOCs:
mg/L VOC Removal%
GW -59 Rev. 212010

FORM ON YELLOW PAPER ONLY
ZR QUALITY MONITORING:
REPORT FORM
Facility Name: Surf City W.W.T.P
Permit Name (if different): -
Facility Address: PO Box 2475
Surf Ci (street) NC 28445
City _ County Onslow
act Person: Steve Smith Telephone## 910-233=5169
Location/Site Name: Zone 15 No. of wells to be sampled: 1
1EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone:
rERMIT Number: Expiration Date: 1-31='
Ion -Discharge wg0000795 UIC
'DES Other .
PE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
Mme' Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
El Water Source Heat Pump ❑ Other:
ELL ID NUMBER (from Permit): Well 7
Date sample collected: 11/1.0/16
pH (Lab) 00403
FIELD ANALYSES:
TOC oosmo 1.8 - -
ell Depth: 28.2 ft.
Weil Diameter: 2 in.
mg/L
pH oo400: 7.36 units
Temp. oo010. 16.9 °C
:pth to Water Level 82546: 0.0 ft. below measuring point Screened Interval: 26.2 ft.
to 28.2 ft.
Spec. Cond. 00094:
µMhos
�asuring Point is 1.7 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: none
Total Ammonia 00610 <2
ilume of water pumped/bailed before sampling: 5.0
gallons
ug/L
Appearance clear
ug/L
Imples for metals were collected unfiltered: L] YES
❑ NO and field acidified: ❑ YES
❑ NO
tBORATORYINFORMATION
-
Ite sample analyzed: see report
Laboratory Name: Envirochem
Certification No. 94
kRAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo6:t5 <.02
mg/L
Pb - Lead o1051
ug/L
Coliform: MP Fecal 31616 <1 /1 OOmL
Nitrate (NO3) as N 00620 <:02
mg/L
Zn - Zinc 01092
mg/L
Coliform: MF Total 31504 /1OOmL
Phosphorus: Total as P 00665 .19
mg/L
.(Note: Use MPN method for highly turbidsamples) - Orthophosphate 70507
Ived Soiids:Total 7030o254
mg/L
pH (Lab) 00403
units
TOC oosmo 1.8 - -
mg/L
Chloride 00940 7
mg/L
Arsenic 01002
ug!L
Grease and Oils 00552
mg/L
Phenol .3273o
ug/L
Sulfate 00945 - _--
mg/L
fic'Conductance 00035
µMhos
Total Ammonia 00610 <2
- mg/L
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
ug/L
TKN as N 006525 -__ mgfL
For Remediation Systems Only (Attach Lab Reports):
AI -Aluminum o1105
mg/L
Ba - Barium 01007
uglL
Ca - Calcium 00916
mg/L
Cd - Cadmium 01027
ug/L
Chromium: Total 01034
ug/L.
Cu - Copper 01042
mg/L
Fe - Iron 01045
ug/L
Hg - Mercury 71900
_ __- ug/L
K - Potassium oo937
mg/L
Mg - Magnesium oo927
mglL
Mn - Manganese 01055
ug/L
Ni - Nicker 01067
ug/L
Influent Total VOCs:
Other (Specify Compounds 01 oncentration Units):
BCE 2 Vi Lit iB
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB' REPORT,)
Lab Report Attached? ❑ Yes (1) ❑ No (0)
VOC 78732: method
method #
method #
method #
mg/L Effluent Total VOCs:
mg/L VOC Removal%Q
Steven Smith ORC Vy" 4 y v 12/12/16
Rermittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW -59 Rev, 212010
at
Of

SUBMIT
TER QUALITY MONITORING:
E REPORT FORM
TY INFORMATION measeennrt,ieanyor type
Name: Surf City W.W.T.P
Name (if different):
Address; PO Box 2475
ty (street) NC 28445
- County Onslow
act Person: Steve Smith Telephone#: [phone]
Location/Site Name: Zone 6 No. of wells to be sampled: 1
ONLY
1EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
"ERMIT Number: Expiration Date: 1-31-17
Jon -Discharge wg0000795 UIC
JPDES Other
XPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
Water Source Heat Pump ❑ Other: _
ELL ID NUMBER (from Permit): Well 8 Date sample collected: 11/10116 FIELD ANALYSES:
ell Depth_ 7.7 H o0400: 5.15 ft. Well Diameter: 2 in.
p units Temp. 000i0: 18.3 °C
tpth to Water Level 82546:5.6 ft. below measuring' point Screened Interval: 4.99 fL to 9.99 ft, Spec. Cond. 00094 - -_ µMhos
�-asuring Point is 3.0 ft. above land surface Relative M.P. Elevation: ft. Odor 000s5: none
flume of water'pumped/bailed before sampling: _5 gallons Appearance mostly clear
imples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
1BORATORY INFORMATION
ite sample.analyzed: see report Laboratory Name: Envirochem Certification No. 94
4RAMETE. RS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO,) as N oo615 {.02 mg/L Pb -Lead of o51 ug/L
Coliform; MF Fecal 31616 <1 /100mL Nitrate (NO3) as N 00620 <,02 mg/L Zn - Zinc o1o92 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as. P oo665 .05
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
solved Solids:Total 70300 49
mg/L
AI -Aluminum oil o5
mg/L
1)
pH (Lab) 00403
units
Ba - Barium 01007
1.1911-
g/LTOC
TOCoo6so 6.4
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 14
mg/L
Cd - Cadmium oio27
ug[L
Arsenic 01002
ug/L
Chromium: Total 01034
_ ug/L-
Grease and Oils 00552
mg/L
Cu - Copper oio42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L-
Fe - Iron oi045 _ _ _
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate oo945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
ecific Conductance oo695 -
µMhos
K - Potassium 00937
mg/L
VOC 78732. method #
Total Ammonia oo6io <-2
mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn - Manganese. 01088
ugh..
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%
Steven Smith ORC / V ---- J v V 12/1
Permittee (or Authorized Agent) Name and Title - Please print or -type Signature of Permittee (or Authorized Agent) (Date
GW -59 Rev. 212010
at
of

GW -59A COMPLIANCE REPORT FORM Permit # W Q 0 0 0 O 1 9
(Submit one each monitoring period with GW -59 forms.)
1
Enter date monitoring results were due. ( 1143ij JG ) Will this monitoring report (GW -59 and GW -59A)
YES
ko
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 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?
ES
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 concentration(s)
exceedin stand {ds in the space 'd db beI II 1
✓G�I S 3 d 1 �— j�`l 1VM� S �1 �J 9� 1 al a- L
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
ES
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 wit constituents) exceeding
standards, concentrations) reported, and sample collection date for each occurrence st two years).
D
6
Are the monitoring wells listed in section 5 located at or beyond the review �ay�4 7o
R0 .
YES
O
If the answer is "YES". a groundwater quality problem may be occurring. CONTACT THERkalb,p4 1
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 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/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.
Ii hereby acknowledge that the above information was evaluated and the information submitted in this
Lrep9rt (Compliance Report_GW-59A) is true and complete to the best of my_knowledge.^
16
Signature of Permittee (or Authorized Agent) Date
GW -59A 12/8/2003