Application - PFAS Remediation Program │ September 2020
4040 Paramount Boulevard, Lakewood, California 90712 Phone (562) 921-5521 Fax (562) 921-6101 www.wrd.org
PFAS Remediation Program Initial Application
Thank you for your interest in WRD’s PFAS Remediation Program. The following application is
designed to be an initial application to understand your PFAS impacts and unique support
needs. Once your application has been received, WRD staff will review and may request
additional information as needed in case further clarification or details are needed about
information supplied in this form. Please make sure to attach the requested supplemental
information (questions 7&8) along with this completed application in one email to Diane Gatza
at Dgatza@WRD.org. All initial applications should be filled out and submitted by September 30,
2020. Once submitted you will receive a confirmation email and Diane will follow up with you as
needed before a joint BAC/TAC meeting in October 2020.
1. How many of your wells currently have PFAS levels at or above the current Response Level (RL)
for PFOA (i.e., > 10 ng/L) or PFOS (i.e., > 40 ng/L)? Provide the official name of your well(s) as
reported to WRD Watermaster and highest reported concentration for PFOA / PFOS. *NOTE if
your agency DOES NOT have wells at or above the RL please skip questions 1&2 and proceed to
questions 3&4)
Highest Reported Concentration in ng/L
List other wells: ________________________________________________________________
2. Of the wells identified in question 1, what is the past three years of production by well reported
to WRD Watermaster? Provide the official name of your well as reported to WRD Watermaster.
Values should be for a twelve-month period and rounded to the nearest whole number.
List other wells: ________________________________________________________________
