HCH-2013-053, New Jersey Pollutant Discharge Elimination System Discharge Monitoring Report

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New Jersey Pollutant Discharge Elimination System Discharge Monitoring Report
ML13275A241
Person / Time
Site: Hope Creek PSEG icon.png
Issue date: 09/24/2013
From: Davison P
Public Service Enterprise Group
To:
Office of Nuclear Reactor Regulation, State of NJ, Dept of Environmental Protection, Bureau of Permit Management
References
HCH-2013-053
Download: ML13275A241 (16)
v • d • e


Text

PSEG Nuclear LLC P.O. Box 236, Hancocks Bridge, New Jersey 08038-0236 SEP 2 4 2013 0 PSEG Nuclear LLC HCH-2013-053 CERTIFIED MAIL RETURN RECEIPT REQUESTED ARTICLE NUMBER: 7011 3500 0000 5084 6208 Department of Environmental Protection Office of Permit Management Division of Water Quality P0 Box 420 Trenton, N.J. 08625-0420 NEW JERSEY POLLUTANT DISCHARGE ELIMINATION SYSTEM DISCHARGE MONITORING REPORT HOPE CREEK GENERATING STATION NJPDES PERMIT NJ0025411

Dear Sir:

Attached is the Discharge Monitoring Report for the Hope Creek Generating Station for the month of August 2013 and the Consolidated Waste Characterization Report for DSN-461C located at Hope Creek.

This report is required by and prepared specifically for the New Jersey Department of Environmental Protection (NJDEP). It presents only the observed results of measurements and analyses required to be performed by the above agencies. The choice of the measurement devices and analytical methods are controlled by the EPA and the NJDEP, not by the company, and there are limitations on the accuracy of such measurement devices and analytical techniques even when used and maintained as required. Accordingly, this report is not intended as an assertion that any instrument has measured, or that any reading or analytical result represents the true value with absolute accuracy, nor is it an endorsement of the suitability of any analytical or measurement procedure.

If you have any questions concerning this report, please feel free to contact Christopher White at (856) 339-3301.

Sincerely,

?044 ý i(0

""7 Paul J. Davison Site Vice President-Hope Creek 95-2168 REV. 7199

SEP 2 4 2013 HCH-201 3-053 2

NJPDES DMR Attachments C

Executive Director, DRBC USNRC - Docket number 50-354

SEP 2 42013 HCH-2013-053 3

NJPDES DMR EXPLANATION OF CONDITIONS August 2013 The following explanations are included to clarify possible deviation from permit conditions.

General - The columns labeled "No. Ex" on the enclosed DMR tabulate the number of daily discharge values outside the indicated limits.

Data reporting and accuracy reflect the working environment, the design capabilities and reliability of the monitoring instruments and operating equipment.

Deviations from required sampling, analysis monitoring and reporting methods and periodicities are indicated on the respective transmittal sheet with explanations below.

Results reported on the Discharge Monitoring Report forms are consistent with permit limits, data supplied from contract laboratories, the December 2007 revision of the NJDEP Monitoring Report Form Reference Manual and specific guidance from DEP personnel.

Sampling frequency was increased for DSN-461A to support the DRBC nutrient monitoring requirements and to obtain additional operational data.

Included is the Consolidated Waste Characterization Report for DSN-461 C.

SEP 2 4 2013 HCH-2013-053 NJPDES DMR 4

EXPLANATION OF EXCEEDANCES August 2013 The following exceedances are included in the attached report and explained below.

DSN No.

EXPLANATION No Exceedances

HCH-2013-053 5

NJPDES DMR COUNTY OF SALEM STATE OF NEW JERSEY I, Paul J. Davison, of full age, being duly sworn according to law, upon my oath depose and say:

1.

I am the Site Vice President-Hope Creek for PSEG Nuclear, and as such am authorized to sign Hope Creek's Discharge Monitoring Reports submitted to the New Jersey Department of Environmental Protection pursuant to the Station's New Jersey Pollutant Discharge Elimination System permit.

2.

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe the submitted information is true, accurate and complete. I am aware that there are significant penalties for submitting false information including the possibility of fine and imprisonment.

3.

The signature on the attached Discharge Monitoring Reports is my signature and I am submitting this affidavit in satisfaction of the requirement that my signature be notarized.

aj

[9 Paul J. Davison Site Vice President - Hope Creek Sworn and subscribed before me this

/

day of September, 2013.

JENNIFE.R M.TI

11) # 23a"t

ýOTjnARY PUBLI OF ON WJ@

New Jersey Department of Environmental Protection Division of Water Quality Surface Water Discharge Monitoring Report Stubmittal Form P1 46815 NJPDES PERMIT MONITORING PERIOD MONITORED LOCATION:

Month Dily Year TMonth IDay Year 461A - DSN 461A - DSW NJ0025411 8

2013 Tol 8

13*11 2013[

PERMITTEE:

PSE&G NUCLEAR LLC PO BOX 236 - ALLOWAY CREEK NECK RD HANCOCKS BRIDGE, NJ 08038 LOCATION OF ACTIVITY:

HOPE CREEK. GENERATING STATION ARTIFICIAL ISLAND FOOT OF BUTTONWOOD RD LOWER ALLOWAYS CREEK, NJ 08038 REPORT RECIPIENT:

PSE&G TRAVIS ZIGO PO BOX 236 / H15 HANCOCKS BRIDGE, NJ 08038 REGION / COUNTY: Southern / Salem County CHECK IF APPLICABLE:

-No Discharge this Monitoring Period Monitoring Report Comments Attached WHO MUST SIGN The highest ranking official having day-to-day managerial and operational responsibilities for the discharging facility shall sign the certification or, in his absence a person designated by that person. For a local agency, the highest ranking operator of the treatment works shall sign the certification. Where the highest ranking operator does not have the ability to authorize capital expenditures and hire personnel, a person having that responsibility or person designated by that person shall also sign the second certification at thej bottom of this page. If the local agency has contracted with another entity to operate the treatment works, the highest-ranking official of the contracted entity shall sign the certification.

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments, and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of and/or imprisonment, pursuant to N.J.A.C. 7:14A-6.9(B). The New Jersey water Pollution Control Act provides for penalties up to $50,000 per violation.

Paul J. Davison. Site Vice President-HoDe Creek N/A NAME AND TITLE OF IRINCIAL EXECUTIVE OFFICER, AUTHORIZED AGENT, OR *LICENSED OPERATOR SIGNATURE OF PRINCIPVL EXECUTIVE OFFICER, AUTHORIZED AGENT, OR -LICENSED OPERATOR GRADE AND REGISTRY NUMBER (IF APPLICABLE)

DATE 856-339-1555 AREA CODE/PHONE NUMBER

  • For a local agency where the highest-ranking operator does not have the abilit' to authorize capital cxpenditmres and hirepersonnel. a person having that responsibilitY or person designated by that person shall sign the.[fllowiing cert~fication:

I certify under penalty of law aid in accordance with N.J.S.A. 58:1OA-6F(5) that I have reviewed the attached discharge monitoring reports.

N/A N/A SIGNATURE N/A DATE N/A AREA CODE/PHONE NUMBER NAME AND TITLE

Surface Water Discharge Monitoring Report P1 46815 PERMIT NUMBER:

NJ0025411 MONITORED LOCATION:

MONITORING PERIOD:

81112013 TO 8/31/2013 FACILITY NAME.

HOPE CREEK GENERATING STATION 461A DSN 461A - DSW I Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

  • 'sex-,,

0'4-Co D

Pre-Print Creation Date: 71112013 Page 1 of 3

Surface Water Discharge Monitoring Report PERMIT NUMBER:

MONITORED LOCATION:

MONITORING PERIOD:

P1 46815 FACILITY NAME:

NJ0025411 461A DSN 461A - DSW 8/1/2013 TO 8/31/2013 HOPE CREEK GENERATING STATION NO.

FREQ. OF SAMPLE PARAMETER QUANTITY OR LOADING UNITS QUALITY OR CONCENTRATION UNITS EX.

ANALYSIS TYPE Temperature, SAMPLE oC 00010 1 PERMIT:*r: :

    • G3:Continous D*
  • METER:....

Effluent Gross Value REIREMENT r*MOA

'1 M

Temperature, SAMPLE I

8 i

/

00010 7 EMT

.ý

-ý,

REPORi~ jREP RT Cntnos ME Intake From Stream RE4RMN IO 00680 1 E*'* M I[

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REP*O RTI* *,'

I *:n

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  • 'Q.,* !':,REI*O RT
  • MrIL--
  • 1*"..

IMi' flUl*

t~r GRA B '

Effluent GrssVlu EQIEMN Carbon, Tot Organic SAMPLE MEASUREMENT MG/L...

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' PERMIT.V EPR (EPORT,!L GP/onl A13D Effluent Net Value RQ IREEN

  • k******* *.*

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Carbon, Tot Organic SAMPLE (TOC)

ASUREMENT PERII 1Moth1

-6A GR.B 00680 7

ýREPORT InaeFo tem REQUIREMENT

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01MOAV4, EPRx M/
Sulateo, TotOral i

SAMPLE (TOC)

MEASUREMENTI 00945 ~ ~

PER~r~

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.. *.*REPORT EPR Effluent Gross Value RUEt*l,1*

.*i***O AMU IComments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pr-Pin CrainDae4//203Pge2o Pre-Print Creation Date: 71112013 Page 2 of 3

  • Surface Water Discharge Monitoring Report PERMIT NUMBER:

MONITORED LOCATION:

MONITORING PERIOD:

NJ0025411 461A DSN 461A - DSW 81112013 TO 813112013 P1 46815 FACILITY NAME.:

HOPE CREEK GENERATING STATION Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pre-Print Creation Date: 7/1/20 13 Page 3of3I Pre-Print Creation Date: 71112013 Page 3 of 3

New Jersey Department of Environmental Protection Division of Water Quality Surface Water Discharge Monitoring Report Submittal Form PI 46815 NJPDES PERMIT MONITORING PERIOD MONITORED LOCATION:

NJ0025411 Month Da Year Ton"l IDaYearI 461C - DSN 461C - DSW internal 8~~

8 _]

31 To 201y~o31 PERMITTEE:

PSE&G NUCLEAR LLC PO BOX 236 - ALLOWAY CREEK NECK RD HANCOCKS BRIDGE, NJ 08038 LOCATION OF ACTIVITY:

HOPE CREEK GENERATING STATION ARTIFICIAL ISLAND FOOT OF BUTTONWOOD RD LOWER ALLOWAYS CREEK, NJ 08038 REPORT RECIPIENT:

PSE&G TRAVIS ZIGO PO BOX 236/ H15 I-IANCOCKS BRIDGE, NJ 08038 REGION / COUNTY: Southern / Salem County CHECK IF APPLICABLE:

No Discharge this Monitoring Period E-Monitoring Report Comments Attached WHO MUST SIGN The highest ranking official having day-to-day managerial and operational responsibilities for the discharging facility shall sign the certification or, in his absence a person designated by that person. For a local agency, the highest ranking operator of the treatment works shall sign the certification. Where the highest ranking operator does not have the ability to authorize capital expenditures and hire personnel, a person having that responsibility or person designated by that person shall also sign the second certification at the bottom of this page. If the local agency has contracted with another entity to operate the treatment works, the highest-ranking official of the contracted entity shall sign the certification.

I certify under penalty of law that 1 have personally examined and am familiar with the information submitted in this document and all attachments, and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of and/or imprisonment, pursuant to N.J.A.C. 7:14A-6.9(B). The New Jersey water Pollution Control Act provides for penalties up to $50,000 per violation.

Paul J. Davison, Site Vice President-Hope Creek N/A NAME AND TITE OF PRINCI cAL EXECUTIVE OFFICER, AUTIHORIZED AGENT, OR *LICENSED OPERATOR SIGNATURE OF PRINCIPAL EXECUTIVE OFFICER, AUTORIZED AGENT, OR *LICENSED OPERATOR GRADE ANI) REGISTRY NUMBER (IF APPLICABLE)

DA4E 856-339-1555 AREA CODE/PIHONE NUMBER

  • For a local agency' where the highest-ranking operator does not have the ability to awthorize capital exJpenilitures and hire per:sonnel, a person having that responsibiliti or person designated by that person shall sign the following certification:

I certify under penalty of law and in accordance with N.J.S.A. 58:1 OA-6F(5) that I have reviewed the attached discharge monitoring reports.

N/A N/A N/A DATE N/A AREA CODE/PHONE NUMBER NAME AND TITLE SIGNATURE

- Surface Water Discharge Monitoring Report PERMIT NUMBER:

MONITORED LOCATION:

MONITORING PERIOD:

NJ0025411 461C DSN 461C - DSW interna 8/1/2013 TO 8/31/2013 P1 46815 FACILITY NAME:

HOPE CREEK GENERATING STATION Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pre-Print Creation Date: 71112013 Page 1 of 1

New Jersey Department of Environmental Protection Division of Water Quality Surface Water Discharge Monitoring Report Submittal Form PI 46815 NJPDES PERMIT MONITORING PERIOD MONITORED LOCATION:

NJ0025411 Month I Day IYer To Mon te 462B - DSN 462B - DSW Internal PERMITTEE:

PSE&G NUCLEAR LLC PO BOX 236 - ALLOWAY CREEK NECK RD HANCOCKS BRIDGE, NJ 08038 LOCATION OF ACTIVITY:

HOPE CREEK GENERATING STATION ARTIFICIAL ISLAND FOOT OF BUTTONWOOD RD LOWER ALLOWAYS CREEK, NJ 08038 REPORT RECIPIENT:

PSE&G TRAVIS ZIGO PO BOX 236 / H15 HANCOCKS BRIDGE, NJ 08038 REGION / COUNTY: Southern / Salem County CHECK IF APPLICABLE:

E-No Discharge this Monitoring Period Monitoring Report Comments Attached WHO MUST SIGN The highest ranking official having day-to-day managerial and operational responsibilities for the discharging facility shall sign the certification or, in his absence a person designated by that person. For a local agency, the highest ranking operator of the treatment works shall sign the certification. Where the highest ranking operator does not have the ability to authorize capital expenditures and hire personnel, a person having that responsibility or person designated by that person shall also sign the second certification at the bottom of this page. If the local agency has contracted with another entity to operate the treatment works, the highest-ranking official of the contracted entity shall sign the certification.

I certify under penalty of law that I have personally examined and amn familiar with the information submitted in this document and all attachments, and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of and/or imprisonment, pursuant to N.J.A.C. 7: 14A-6.9(B). The New Jersey water Pollution Control Act provides for penalties'up to $50,000 per violation.

Paul J. Davison. Site Vice President-Hope Creek N/A NAME AND TITLE OF PRINCIPAL EECUTI VE OFFICER, AUTItORIZED AGENT, OR *LICENSEI) OPERATOR SIGNATURE OF PRINCIPAL EVECUTIVE OFFICER, AUTIIORIZED AGENT, OR *LICENSED OPERATOR GRADE AND REGISTRY NUMBER (IF APPLICABLE)

DATE 856-339-1555 AREA CODE/PHONE NUMBER

  • For a local agency where the highest-ranking operator does not have the a/bi/ilt' to authorize capital expenditmees and hire personnel, a person having that responsibility or person designated by that p)eison shall sign the.ifllowing certification:

I certify Under penalty of law and in accordance with N.J.S.A. 58:1 OA-6F(5) that I have reviewed the attached discharge monitoring reports.

N/A NAME AND TITLE N/A N/A DATE N/A SIGNATURE AREA CODE/PIIONE NUMBER

Surface Water Discharge Monitoring Report PI 46815 PERMIT NUMBER:

NJ0025411 MONITORED LOCATION:

462B DSN 462B - DSW Interna MONITORING PERIOD:

81112013 TO 813112013 FACILITY NAME:

HOPE CREEK GENERATING STATION NO.

FREQ. OF SAMPLE PARAMETER QUANTITY OR LOADING UNITS QUALITY OR CONCENTRATION UNITS EX.

ANALYSIS TYPE Flow, In Conduit or SAMPLE

/z Thru Treatment Plant MAUEN oý OBT 50050 1 R:IPERMITq REPORTP*

--A'REPORT1 MGD

1.

C ruii i,...METER..

BEQUIREMENT S01PMOV""***

t.O Effluent Gross Value

.7; 3/4.-t' BOD, 5-Day (20 oC)

SAMPLE MEASUREMENT 00310 G

-PERMITt M./L R

.RQUREEN Ar D--'A MX.***..

,PECN Raw Sew/influent t~MN 777< 7IOVAlDM QL

        • 1MOA*

VMH¶/r

            • ,~t.

j..

.*pi.*;

BOd, 5-Day (20 oC)

SAMPLE MEASUREMENT 17o 0053GRIPTPERMIT 31 R.0 46 llMoiith iCOMPOS 003AY 1

MG/L

,RQLRt#W %1 W kAV 4,

OIWK'1 RaEw/ifluent Gros Vaue416.

BOO, 5-Day (20 oC)

SAMPLE fi MEASUREMENT****'i-****j

'/~u Lct 00310 K

'PRI8..

~

7.5 I/Month CA' PERCNT Percent Removal RqURVN t****-

1.'

24.

Solids, Total SAMPLE Suspended MEASUREMENT

(

S 0

Gre PERMIT Gi of t REPORTf W r gRPOrtting at 1/Mon Prawe win fREQUIREMENT Cre01M'e d!

PDMX M

O Ra Sew/influent j

Solids, Total SAMPLE 6

/o41-C6l\\0s Suspended MEASUREMENT I*** - F I

.6/oaVK (n\\o 00530 1 M.PRIG'/L

~

  • F

[~~ 1

1Mnh CMO Effluent Gross Value

-'Vw~

A Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pre-Print Creatf/on Date: 7/1/120 13 Page 1 of 2

Surface Water Discharge Monitoring Report P1 46815 PERMIT NUMBER:

NJ0025411 MONITORED LOCATION.

MONITORING PERIOD.

FACILITY NAME:

462B DSN 462B - DSW Interne 811/2013 TO 8/31/2013 HOPE CREEK GENERATING STATION NO.

FREQ. OF SAMPLE PARAMETER QUANTITY OR LOADING UNITS QUALITY OR CONCENTRATION UNITS EX.

ANALYSIS TYPE Solids, Total SAMPLE oI Suspended MEASUREMENT 9(0

(..

95 71 Vic YtI\\

C-r"1 00530 K PEMTTD4ý

,5 RPR~

~~

~

1~ii~'~A Q IE ET, 011MOAVMN.,

0,1MOV Percent Removal REQUIREMENT

? *,

01 MOAVMN PERCENT 00556 1 rr 10 I'

M1.Month*

GRA PERI MGIL REQUIREMENTý 0 DA***M~~

's MA Effluent Gross Value

  • .01.

Nitrogen, Ammonia SAMPLE T....

I I

I1 M /L REQUIREMENT 1O*

0.1 DA'MX`*I 2

MEASUREMENT 7f

'ý'3165

'/o~nthi-GRMPOS" 61211 1 E..

  1. 1100ML ValueE ON I M06

! 't*

P!l;

,,:":'t '*'

Effluent Gross Value REQUIREMENTI

',y,,

EneoiorFcai SAMPLE 4

II MEASUREMENT

  • 0 I*/,(

n>I4Io0."GP3..A REQIRMN I

fi 4010,GE Effluent Gross Value 72 PagI2MfG LbCertifirFcatinl SAMPLE MEASUREMENT I*PA*C (1Q 74055 19 "yEPERMIT-RW6R REOR4 RE RT 40NO REQUIREMENT Lab La 4L Laab Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pre-Print Creation Date: 7/1/12013 Page 2 of 2

New Jersey Department of Environmental Protection Division of Water Quality Consolidated Waste Characterization Report Submittal Form P1 46815 PERMITTEE:

PSE&G NUCLEAR LLC PO BOX 236 - ALLOWAY CREEK NE HANCOCKS BRIDGE, NJ 08038 LOCATION OF ACTIVITY:

HOPE CREEK GENERATING STATION ARTIFICIAL ISLAND FOOT OF BUTTONWOOD RD LOWER ALLOWAYS CREEK, NJ 08038 REPORT RECIPIENT:

PSE&G TRAVIS ZIGO PO BOX 236 / H15 HANCOCKS BRIDGE, NJ 08038 REGION / COUNTY: Southern / Salem County CHECK IF APPLICABLE:

[]No Discharge this Monitoring Period

[]Monitoring Report Comments Attached WVHO MUST SIGN The highest ranking official having day-to-day managerial and operational responsibilities for the discharging facility shall sign the certification or, in his absence a person designated by that person. For a local agency, the highest ranking operator of the treatment works shall sign the certification. Where the highest ranking operator does not have the ability to authorize capital expenditures and hire personnel, a person having that responsibility or person designated by that person shall also sign the second certification at the bottom of this page. If the local agency has contracted with another entity to operate the treatment works, the highest-ranking official of the contracted entity shall sign the certification.

I certify under penalty of law that I have personally examined and am familiar with the information submitted in this document and all attachments, and that, based on my inquiry of those individuals immediately responsible for obtaining the information. I believe that the information is true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of and/or imprisonment, pursuant to N.J.A.C. 7:14A-6.9(B). The New Jersey water Pollution Control Act provides for penalties up to $50,000 per violation.

Paul J. Davison, Site Vice President - Hope Creek NAME AND TITLE OF PRINCIPAL EXECUTIVE OFFICER,OR AUTHORIE AGENT SIGNATURE OF PRIN AL EXECUTIVE OFFICER OR AUTHORIZED AGENT N/A GRADE AND REGISTRY NUMBER (IF APPLICABLE)

'~( 3 856-339-1555 DATE(MONTH/DAY AREA CODE/TELEPHONE NUMBER

/YEAR)

  • For a local agency where the highest-ranking operator does not have the ability to authorize capital expenditures and hire persoMnel a person having that responsibility orperson designated by thatperson shall sign thefollowing certification:

I certify under penalty of law and in accordance with N.J.S.A. 58:10A-6F(5) that I have reviewed the attached discharge monitoring reports.

N/A NAME AND TITLE N/A DATE N/A SIGNATURE N/A AREA CODE/PHONE NUMBER

Cdonsolidated Waste Characterization Report P1 46815 PERMIT NUMBER:

MONITORED LOCA TION:

MONITORING PERIOD:

FACILITY NAME:

NJ0025411 461C DSN 461C - DSW intern 7/1/2013 TO 12/31/2013 HOPE CREEK GENERATING STATION SAMPLE DATE OF REPORT.:

c/

PARAMETER QL REPORTED UNITS REMARK SAMPLE VALUE CODE TYPE Nitrogen, Ammonia Total (as N)

UGIL GRAB 00610 Effluent Gross Value I T-i UG/L GRAB Zinc, Total Recoverable UGIL GRAB 01094 Effluent Gross Value RQL =10 1

I __UGI GRAB Cadmium, Total Recoverable I

G 01113 Effluent Gross Value RQL=4 1(

0 UG/L GRAB Copper, Total Recoverable UGIL GRAB

[01119 Effluent Gross Value RQL2

= 2, I'

UG/L GRAB Dichlorobromomethane 32101 Effluent Gross Value RQL=6 K,

I UG/L GRAB Chloroform II/

I GRAB 132106 Effluent Gross Value RQL =5 1

JUGLGA Lab Certification #

N/A 199999 Lab (II NOTAP La etfcto99999 L-ab

_____)___

__NOT___

AP____

Lab Certification #

NOTAP

[99999 Lab I

Lab Certification #

NOTAP 199999 Lab 1

Lab Certification #

NOTAP 99999 Lab I

Lab Certification #

OA 199999 Lab I_______

Comments: If there are any questions regarding the monitoring report form, please contact Heather Genievich of the Bureau of Surface Water Permitting at (609) 292-4860.

Pre-Print Creation Date: 71112013 Page I of I

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