528774540.

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PERMIT APPLICATION FOR AUTHORIZATION TO CONSTRUCT GROUNDWATER

MONITORING WELLS

1. BASELINE GROUNDWATER QUALITY

a) Provide the location of the monitoring wells used to conduct the baseline
groundwater study

Drawings No. _________________

b) Complete the following table providing information on the baseline groundwater

quality constituent that will or may be present in the wastewater

Parameter Concentration
(mg/l)

2. PROPOSED LOCATION OF THE PERMANENT MONITORING WELLS

Provide the location of the monitoring wells used to conduct the baseline
groundwater study

Drawings No. _________________

W8-1
Facility: ______ Initials: ______