WQ0014565_Monitoring - 11-2016_20170103 (2)

("W -59A COMI'LIANCE REPORT FORM, Po -mit -#!,VQ001qy( 's
( ubinii one each ntowfwt.ng period Wth €i it' -59 fin am)
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?
Y S
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
kZO
identification plate, area overgrown, etc.)? ff the answer is "Yes", contact the Regional Officefor 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 constituent(s) and concentration (s)
exceeding standards in the space provided below:
fY1 0,j PH m -J-3 P14 raw- prl
mw a P14 raw—q y�H
5
For the constituents identified in question 4 above, have standards been exceeded previously for the I
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).
MW -1 •pH 31,11/15, �I�y/IS/2/3c/I I, { c�c2 X129/14 (MW -la pH 8/31/0�)11/1i/ts,'41304r $/3o//b
yAuj_,. ptl yl3ail�o� �13njlbi 3/L'1jIS, II/hl1S
pAW -3 Ptl 31i4/Is, 1t 2slls, y13c11b, B/3o]Id
nlv!-+� �H 8/3iIISt �III111Sr y13dflb„ si3ollb
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 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
N�
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
fines, and/or penalties.
z
1
g
The person completing this portion (G M ) QMhe� dnitodng report should sign below and submit this
form with GW -59 forms for required wa%g th add<ss provided at the top of the current GW -59 form.
res ,
I hereby acknowledge that the above i rmatior'w�sw aluated and the information submitted in this
report (Compliance Report GW -59A) is ue and to„the best knowledge.
compute of,my
PI—CLI
t 0� 3011 �i
Signature of Permittee (or Authorized Agent) Date
GIV-5(M 12;812003

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
- Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010
mg/L Effluent Total VOCs:
Signature oTPermittee (or
�OZvc_�
mg/L VOC Removal%
• •
DEPARTMENT OF ENVIRONMENT S NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00014565 Expiration Date:
Facility Name: Pilgrim's Pride Corporation
Non -Discharge UIC
Permit Name (if different): Gold Kist, Inc.
NPDES Other
Facility Address: 484 Zimmerman Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford NC
27330 County Lee
© Lagoon ❑ Remediation: Infiltration Gallery
,aryl (Stale)
tzpl
© Spray Field ❑ Remediation:
Contact Person: Tina Pedley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Processing Plant
No. of wells to be sampled:
5
❑ Water Source Heat Pump ❑ Other:
Trom Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW -4
Date sample collected:
11/9/2016 FIELD ANALYSES:
WAS
Well Depth: 18.20 ft.
Well Diameter: 2 in.
pH 00400: 6.02 units Temp. o0o10 17.8 °C
DRY at
Depth to Water Level 82546: 7.09 ft. below measuring point
Screened Interval: ft.
to ft. Spec. Cond. 00094: 273 µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 00085: _ _
check
Volume of water pumped/bailed before sampling:
5.50 gallons
Appearance
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 11/09-11/15/16
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo61s
mg/L Pb - Lead wom ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 3.03
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 144
mg/L
Al - Aluminum oil o5
mg/L I
pH (Lab) 00403
units
Ba - Barium 01007
ug/L T�
TOC 00680 <1.0
mg/L
Ca - Calcium 00916
mg/L ®®
Chloride 00940 59.8
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg = Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 273
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 00610 <0.1
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese olos5
ug/L method #
TKN as N 00629
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
- Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010
mg/L Effluent Total VOCs:
Signature oTPermittee (or
�OZvc_�
mg/L VOC Removal%

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs:
//a'Vi �/ Ad (o e -C .vq
Permittee (or Authorized Agent) Name and Title- Please print or type
GW -59 Rev. 2/2010
Agent)
mg/L VOC Removal%
• .
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
• . •
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00014565 Expiration Date:
Facility Name: Pilgrim's Pride Corporation
Non -Discharge UIC
Permit Name (if different): Gold Kist, Inc.
NPDES Other
Facility Address: 484 Zimmerman Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford NC
27330
County Lee
© Lagoon ❑ Remediation: Infiltration Gallery
(Cry) (State)
(Zip)
© Spray Field ❑ Remediation:
Contact Person: Tina Pedley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Processing Plant
No. of wells to be sampled:
5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW -6
Date sample collected:
11/9/2016 FIELD ANALYSES:
WAS
Well Depth: 20.50 ft.
Well Diameter: 2 in.
pH 0040o: 5.09 units Temp. 000lo 16.4 °C
DRY at
Depth to Water Level 82546: 12.72 ft. below measuring point
Screened Interval: ft.
to ft. Spec. Cond. 00094: 216 µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 00085:
check
Volume of water pumped/bailed before sampling:
1.25 -Dry
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑_YES ❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 11/09-11/15/16
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead o1051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.402
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P ooe65
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 116
mg/L
Al -Aluminum oil o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC oos8o 2.14
mg/L
Ca - Calcium 00916
mg/L N 0 A 2017
Chloride 00940 53.0
mg/L
Cd -Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L VM F
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 216
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia ocelo <0.1
mg/L
Mg - Magnesium oo927
mg/L method #
(Ammonia Nitrogen; NH,, as N; Ammonia Nitrogen, Total)
Mn - Manganese olos5
ug/L 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:
//a'Vi �/ Ad (o e -C .vq
Permittee (or Authorized Agent) Name and Title- Please print or type
GW -59 Rev. 2/2010
Agent)
mg/L VOC Removal%

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L
Effluent Total VOCs:
mg/L VOC Removal%
GW -59 Rev. 2/2010
DEPARTMENT OF ENVIRONMENT I NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00014565 Expiration Date:
Facility Name: Pilgrim's Pride Corporation
Non -Discharge UIC
Permit Name (if different): Gold Kist, Inc.
NPDES Other
Facility Address: 484 Zimmerman Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford NC
27330
County Lee
© Lagoon ❑ Remediation: Infiltration Gallery
(041 (SNe)
(Z -P)
© Spray Field El Remediation:
Contact Person: Tina Pedley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Processing Plant
No. of wells to be sampled:
5
❑ Water Source Heat Pump ❑ Other:
from Permit
_
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MWA
Date sample collected:
11/9/2016 FIELD ANALYSES:
WAS
Well Depth: 16.75 ft.
Well Diameter: 2 in.
pH 0040o: 5.49 units Temp. 000io 16.6 °C
DRY at
Depth to Water Level 82546: 10.69 ft. below measuring point
Screened Interval: ft.
_
to ft. Spec. Cond. 00094: 19.7 µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 00085:
check
Volume of water pumped/bailed before sampling:
1.75 -Dry
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑
YES ❑
NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 11/09-11/15/16
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal
concentrations.
COD 00335
mg/L
Nitrite (NO2) as N ooms
mg/L Pb - Lead o1o5i ug/L
Coliform: MF Fecal 31616 70
/100mL
Nitrate (NO3) as N 00620 0.23
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P 0o665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 28.0
mg/L
Al - Aluminum o1105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L����
TOC oomo 1.09
mg/L
Ca - Calcium oo91s
mg/L
Chloride 00940 7.34
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 19.7
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 0omo X0.1
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L 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%
GW -59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs:
_ —7 .'G/- !o.—C',
Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010
of Permittee (or Authorized
mg/L VOC Removal%
• •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
• • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00014565 Expiration Date:
Facility Name: Pilgrim's Pride Corporation
Non -Discharge UIC
Permit Name (if different): Gold Kist, Inc.
NPDES Other
Facility Address: 484 Zimmerman Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford NC
27330 County Lee
© Lagoon ❑ Remediation: Infiltration Gallery
cry) State)
Zip)
© Spray Field ❑ Remediation:
Contact Person: Tina Pedley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Processing Plant
No. of wells to be sampled:
5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW -2
Date sample collected:
11/9/2016 FIELD ANALYSES:
WAS
Well Depth: 35.00 ft.
Well Diameter. 2 in.
pH 00400; 5.73 units Temp. 00010 16.8 °C
DRY at
Depth to Water Level 82546: 18.69 ft. below measuring point Screened Interval: ft.
to ft. Spec. Cond. 00094: 111 µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 00085:
check
Volume of water pumped/bailed before sampling:
8.00 gallons
Appearance
here:❑
Samples for metals were collected unfiltered: ❑
YES
❑ NO and field acidified: El YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 11/09-11/15/16
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo615
mg/L Pb - Lead 01.051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.858
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 _
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 63.0
mg/L
AI - Aluminum oil o5
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC oo68o X1.0
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 27.8
mg/L
Cd - Cadmium 01027
ug/L 1a �eglg
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 111
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia 0061 o <0.1
mg/L
Mg - Magnesium 00927
mg/L , method #
(Ammonia Nitrogen; NH3 as N Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L 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:
_ —7 .'G/- !o.—C',
Permittee (or Authorized Agent) Name and Title - Please print or type
GW -59 Rev. 2/2010
of Permittee (or Authorized
mg/L VOC Removal%

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs:
and Title - Please print or type
GW -59 Rev. 212010
Signature of Permittee (or
mg/L VOC Removal%
(Date)
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00014565 Expiration Date:
Facility Name: Pilgrim's Pride Corporation
Non -Discharge UIC
Permit Name (if different): Gold Kist, Inc.
NPDES Other
Facility Address: 484 Zimmerman Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Sanford NC
27330
County Lee
© Lagoon ❑ Remediation: Infiltration Gallery
(C ry) Sta;zt
�Z.p)
© Spray Field ❑Remediation:
Contact Person: Tina Pedley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Processing Plant
No. of wells to be sampled:
5
❑ Water Source Heat Pump ❑ Other:
(from Parmit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW -3
Date sample collected:
11/9/2016 FIELD ANALYSES:
WAS
Well Depth: 16.10 ft.
Well Diameter: 2 in.
pH 00400: 6.00 units Temp. 0oolo 16.7 °C
DRY at
Depth to Water Level 82546: 8.78 ft. below measuring point
Screened Interval: ft.
to ft. Spec. Cond. 00094: 474 µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 000e5:
check
Volume of water pumped/bailed before sampling:
3.00 -Dry
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 11/09-11/15/16
Laboratory Name` Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal
concentrations.
COD 00335
mg/L
Nitrite (NO2) as N oo615
mg/L Pb - Lead aims ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 1.20
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P 0o665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
_ _ mg/L Other (Specify Compounds ando�nncentration Units):
Dissolved Solids:Total 70300 277
mg/L
Al -Aluminum ollo5
mg/L ® 4 2017
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 <1.0
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 78.2
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 0009s 474
µMhos
K - Potassium 00937
mg/L VOC 78732: method #
Total Ammonia ooelo <0,1
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia, Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L 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:
and Title - Please print or type
GW -59 Rev. 212010
Signature of Permittee (or
mg/L VOC Removal%
(Date)