WQ0002128_Monitoring - 11-2016_20170112

t % t r "t v
GR-ODINDWAtER QUALITY MONITORING
COMPLIANCE .R.EPORT FORM
FACILITY INFORMATION Please Print Clearly. or Type
Facility Name:
Permit Name .(if different). _
Fagity Address:
`�;nY7 Stale
Contact .Person. � ""LI.'R County A :a e -
(zip)
Telephone #: _A'2 — 7 i's ,L(.
Well Location/ Site Name: No. of Wells to be Sampled:_
Well Identification Number (from Permit): __ Z nr P�t,i
Well Depth:. '}.1 for Groundwater Treatment Systems
ft. Well Diameter: _a._ in.: Cheek One: ❑ 'In€Iuent (9.8)
Screened Interval: ft. to - ft.
Depth to Water Level: 1.. ft.. below measuring point. El Effluent (99)
Measuring Point M'.. P.) -is
f-asurace.Relative MY Elevation fl ft -
Gallons of water pumped/bailed before sampling: Date sample collected: !\
Field analysis: pHA , Specific Conductance
uMhos
Temp. al. °C, Odor Appearance
D.EPARTMENT_OF ENVIRONMENT & .NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #:
EXPIRATION DATE:
Non -Discharge :,,���-,
UIC
NPOES
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.
Date sample analyzed,:
Laboratory Name in e) Jro . �
Certification No..
YE$ NO)
N i 4'N ibk6m V
Rb .- Lead. mit
Zn. - Linc mg/1
Ammonia Nitrogen 6X31 In,0/1
ORGANICS: (GC,GC/MS,HPLC)
(Specify :test and method#. An lab report.) .
Report Attached? Yes,_!�C_(1) NO (0)
yoc : ,method
method # _ .