WI0400538_Permit (Issuance)_20200131

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ENVIRONMENTAL • GEOTECHNICAL
BUILDING SCIENCES • MATERIALS TESTING
December 30, 2019
2725 East Millbrook Road
Suite 121
Raleigh, NC 27604
Tel: [phone]
Fax: [phone]
www.atcgroupservices.com
N.C. Engineering License No. C-1598
Ms. Shristi Shrestha
North Carolina Department of Environmental Quality
Division of Water Quality - Aquifer Protection Section, UIC Program
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Reference: Notice of Intent to Construct or Operate Injection Wells
United States Postal Service - Bulk Mail Center
3701 West Wendover Avenue
Greensboro, Guilford County, North Carolina
NCDEQ Incident No. 4013
Priority Site Ranking: I180D
Dear Ms. Shrestha:
ATC Associates of North Carolina, P.C. (ATC) has prepared the enclosed Notice of Intent to
Construct or Operate Injection Wells on behalf of The Louis Berger Group, Inc. The permit
application covers the performance of passive remediation in three monitoring wells associated
with the above referenced site.
If you have questions or require additional information, please contact our office at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Ashley M. Winkelman, P.G.
Senior Project Manager
cc: Shannon McKinney, Environmental Scientist for The Louis Berger Group, Inc.
Email: [e-mail]
Attachments

Notice of Intent to Construct or Operate Injection Wells
United States Postal Service — Bulk Mail Center, Greensboro, North Carolina
NOTICE OF INTENT FORM
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E>tE�RONMEN1AL • OEUMMICAL
N1111GISG iE1UM • WIMILMSI N6

NC Department of Environmental Quality — Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructer) in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to iniection)
AQUIFER TEST WELLS (15A NCAC 02C .0220}
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals [ ill Be Returned as Incomplete.
DATE: December 30 , 20 19 PERMIT NO. W1040053,9 (to be filled in by DWR)
NOTE- If this NOI is being submitted as notification of a modification of a previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
Permit No. WI Issued Date:
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, J, M
(2) Aquifer Test Well.......................................Complete sections B through F, J, M
(3) Passive Injection System...............................Complete sections B through F, H-M
(4) X Small -Scale Injection Operation ......................Complete sections B through M
(5) Pilot Test.................................................Complete sections B through M
(b) Tracer Injection Well...................................Complete sections B through M
B. STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 10-14-2019 Page 1

C.
E.
F.
G.
WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): US Postal Service — Gardner Jones, Environmental Engineer - Facilities
Mailing Address: 3701 W. Wendover Avenue
City: Greensboro State: NC_ Zip Code:
27495 County: Guilford
Day Tele No.: 336-665-2885 Cell No.:
Not Available
EMAIL Address: gardnenjonesausps.gov Fax No.:
Not Available
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title:
Company Name
Mailing Address:
City: State: Zip Code: County:
Day Tele No.:
Cell No.:
EMAIL Address:
Fax No.:
PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Ashley Winkelman, F.G., Senior Project Manager
Company Name ATC Associates of North Carolina, P.C.
Mailing Address: 2725 E. Millbrook Road, Suite 121
City: Raleigh State: NC_ Zip Code: 27604
County: Wake
Day Tele No.. 919-871-0999
Cell No.: 919-830-3576
EMAIL Address: ashley.winkelman(i4atcgs.com
Fax No.: 919-871-0335
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: United States Postal Service — Bulk Mail Center
3701 W. Wendover Avenue
City: Greensboro County: Guilford Zip Code: 27495
(2) Geographic Coordinates: Latitude": " or 36 05863
Longitude": ° " or 79 ° 87357
Reference Datum: WGS84 Accuracy: 10-meter
Method of Collection: DOQ-Acme Mapper 2.2
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Land surface area of contaminant plume: 5,350 square feet
Land surface area of inj. well network: 1,580 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 29.5% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 10-14-2019 Page 2

H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
The following figures are included in this NOI:
Figure 1— Site Topographic Map
Figure 2 — Site Map
Figure 3 — Dissolved Benzene Isoconcentration Contour Map
Figure 4 — Dissolved Naphthalene Isoconcentration Contour Map
Figure S Geologic Transect Map
Figure 6 — Geologic Cross -Section A -A'
Figure 7— Geologic Cross Section B-B'
Figure 8 — Groundwater Elevation Contour Map
Please note there are no comprehensive soil maps prepared for this site; however, historical assessment activities
indicate there are no exceedances of the Industrial/Commercial Maximum Soil Contaminant Concentrations,
which are considered the applicable soil cleanup goal for this site.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE — Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
ATC will gravity feed four kilo erams of Enviro-BAC each into monitorine wells MW-6. MW-13. and MW-14
in order to aide in natural attenuation and abate light non -aqueous phase liquid (LNAPL). Based on the most
recent samplin event vent performed in May 2019, LNAPL was detected in monitoring wells MW-6, MW-13, and
MW-14 at a thickness of 0.17 feet, 0,94 feet, and 1.27 feet, respectively. The injectate, followed by 20 gallons
of municipal water, will be poured into each well over up to a 3 hour time period per well as to minimize
disruption to the water column. Followingthe he injection event, ATC will install absorbent socks in each well to
facilitate free product recovery. The socks will be replaced on a weekly basis for one month.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed 3 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 28 to 30 feet (depth of injection wells)
(3) For Proposed wells or Existing wells not having GW-Is, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 10-14-2019 Page 3

A well construction record was not available for MW-6. Details for the well are provided below. A soil
boring log for MW-6 and well construction records for MW-13 and MW-14 are included as Appendix A.
MW-6 Well Construction Details:
(a) Permanent
(b) Depth — 28 feet; Well Screen — 18-28 feet; Well Riser — 0-18 feet; Grout type, grout depth, and sand pack
depth are unknown.
(c) Well Contractor — Groundwater Protection; Driller — C. Aiken; Certification Number unknown.
K. INJECTION SUMMARY
NOTE: Only injectants approved by the epidemiology section of the NC Division of Public Health, Department
of Health and Human Services can be injected. Approved iniectants can be found online at
http://deq.nc. gov/about/divisions/water-resources/water-resources-12ermits/wastewater-branch/ground-watcr-
rotection/ round -water -a roved-injectants. All other substances must be reviewed by -the DHHS rior to use.
Contact the UIC Program for more info if you wish to get approval for a different additive. However, please
note it may take 3 months or longer.
Injectant: Enviro-BAC Total Amt. to be injected (gal)/event: Approximately gallons (12 kilograms)
Amt. Water to be injected (gal/event): 60 gallons
Total Amt. to be injected (gal/event): 75 gallons
No. of separate injection events: I Est. Total Amt, to be injected (gal): 75 eallons
Source of Water (if applicable): City of Greensboro Municipal Water
A Safety Data Sheet for Enviro-BAC is included in Appendix B.
L. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
ATC will perform a groundwater monitoring event thirty days after the injection event. Samples will be collected
from a total of six wells, including wells MW-6, MW-13, and MW-14. The samples will be analyzed for volatile
organic compounds by EPA Method 6200B and semi -volatile organic compounds by EPA Method 625. The
samples will be shipped to SGS Accustest in Scott. Louisiana. ATC will also measure dissolved oxygen,
conductivity, temperature, pH, and oxygen reduction potential during the sampling event.
M. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, 1 believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection well and all related appurtenances in accordance with the 1 SA NCAC 02C 0200 Rules. "
Digitally signed by Gardner Jones III
Gardner Jones III DN cn-GardnerJones III, o, ou=Eastern F50,
_�maif=nardnerjones anu�p�,00v. c=lJS
Signature of Applicant Date: zozo.01.02 1054s5-0509 Print or Type Full Name and Title
Deemed Permitted GW Remediation NOI Rev. 10-14-2019 Page 4

Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection wells) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection wells) conform to the Well Construction Standards
(15A NCAC 02C . 0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the land owner, in the
absence of contrary agreement in writing.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 10-14-2019 Page 5

Notice of Intent to Construct or Operate Injection Wells
United States Postal Service — Bulk Mail Center, Greensboro, North Carolina
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ASSOCIATES INC _ [phone]
PROJECT NO: 45.07059.0001
(SCALE: 1" = 770' 1 JUNE 2014 1 PREPARED BY: GO
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Notice of Intent to Construct or Operate Injection Wells
United States Postal Service — Bulk Mail Center, Greensboro, North Carolina
APPENDIX A
MONITORING WELL CONSTRUCTION DETAILS
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SAMPLING NOTES
INTERVAL RECOVERY
NO. I TYPE I I BLOWS I %
5-6
741
5-7
1145
8-8
10-13
5-7
8-9
5-5
5-8
4-5
7-8
5-6
740
4-6
7-9
5-7
9-10
2-4
947
3-5
10-12
6-7
942
0
S
63 ND
1 )0 ND
0
79 ND
79 ND
10
15
100 ND
63 ND
1 )0 26 20
Sz
1 )0 2
100 70
25
83 6
30
35
GENERAL NOTES
DATE STARTED 6 JAN 93
DATE COMPLETED 6 YAW 93
RIG DIEDRICH D420
CREW CHIEF Co AMN
LOGGED LAM CHECKED
Gravel fill
BORING NO. MW-6
SHEET NO. I OF 1
PROJECT NO. 765.65
INSTALLATION
SURFACE ELEV, 845.4
BOREHOLE DIA, 8 IN.
VISUAL CLASSIFICATION
AND GENERAL OBSERVATIONS
moist;
- as above; gray in color.
- as above; brick red in color.
SILT (ML) -soft; micaceous; moist; orangish tan. - - - - - - - - -�
SANDY SII.T (ML) -slightly clayey; moist; mottled; tan and
white. [Saprolite]
SILT (ML) - slightly sandy; firm; wets grayish tan with some
orange banding.
SANDY SILT (ML) - firm; wet, mottled; white with some
orange. [Saprolite]
SILT (ML) -slightly sandy; firm; wet; gray, tan and orange.
0001kVi
WATER LEVEL OBSERVATIONS
WHII,E DRIILING � 22.0 FT
AT COMPLETION 1 23.3 FT.
AFTER DRILLING
CAVE-tN: DATE/TIgE
DEPTH
WATER: DATE/TIME DEPTH

WELL CONSTRUCTION RECORD
This loan can be used tier single or multiple wells
For Internal Use ONLY:
1. Well Contractor Information:
VINCE FEDERLE
Well Contractor Name-- --
A - 3552
NC Well Contractor Cerlitication Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit #:
List all applicable well construction pernits (i.e. County, State, I'm•iauce, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural ❑Municipal/Public
❑Geothermal (Heating/Cooling Supply) ❑Residential Water Supply (single)
❑Industrial/Commercial ❑Residential Water Supply (shared)
❑Irri atlon
Non -Water Supply Well:
mmonitoring ❑Recovery
injection vvell:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heat ine/Cooline
4. Date Well(s) Completed:
5a. Well Location:
LISPS
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under #21 f
05/04/15 Well ID# MW-13
Facility/Owner Name Facility ID# (ifapplieable)
3701 WEST WENDOVER AVENUE GREENSBORO 27407
Physical Address, City, and Zip
GUILFORD
Ceunh' Parcel Identification No. ('PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(ifwell field, one tat/long is sufficient)
360 03' 26.24" N 790 52' 30.32" W
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this a repair to an existing well: ❑Yes or ElNo
lfthis is a repair, fill out known swell construction titbrtnation and egplain the nalare of the
repair under '121 remarks section at- on the back of this farm.
8. Number of wells constructed: 1
Far multiple h jection ar non -aster supply wells ONLY with the sane construction, you can
submit one firm.
9. "Total well depth below land surface: 30.0
Por multiple swells list all depths ifdi&rent (example- 3 a 200' and 2@ 100')
10. Static water level below top of casing: 24.0
/f hater level is above caving, use "
80
14. WATER ZONES
FROM
'1'O
DESCRIPTION
fr.
ft.
15, OUTER CASING for multi -cased wells) OR LBIIER if u r
F120M
'1'O
DIAM ETE.12
)licable
'1't11C'I:NESS
111A'1'EIHAL
ft.
ft.
in.
16.,INNER CASING OR T[JBING "eothern"d'cfosed-loo r
FROM
TO
DIAMETER
'THICKNESS
MATERIAL
0.0 ft
15.0 ft'
2.0 in'
SCH 40
PVC
17, SCREEN
FROM
TO
DIAMETER
SLOTSIZE
'THICKNESS
MATERIAL
15.0 ff
30.0 ff•
2.0 ""
.010
SCH 40
PVC
ft.
fL
in.
18. GROUT
FROM
TO
MATERIAL
EMPI.e\CEMENT METHOD & AMOUNT
00 ft.
11.0 ft'
PORTANOaENTONITE
SLURRY
It.
ft.
ft.
fr.
19. SAND/GRAVEL PACK (if applicable) >
FROM
TO
MATERIAL
EMPLACEMENTMETHOD
13.0 ft'
30.0 ff•
20-40
FINE SILICA SAND
ft.
20. DRILLING LOG (attach additional sheets Unnecessary)
FROM
TO
DESCRIPTION (color, hardness, soittrocic type, Brain size, e(c.)
0.0 ft.
10 ft.
CONCRETE
1.0 ft'
5.0 ft.
GRAVEL
5.0 ff•
30.0 ff•
RED/BROWN SANDY CLAYEY SILT
ft.
ft.
ft.
fr.
ft.
ft.
ft.
ft.
21. RENIARKS
BENTONITE SEAL FROM 11.0 TO 13.0 FEET
22. Certification:
05/19/15
Signature of Cernhed \hell Contractor Date
BY signing this farm, I hereby certify that the Drell(,+) "'as (mere) constructed in accordance
Irith 15A NCAC 02C .0100 at- 1511 NCAC 02C .0200 Well Consiructon Siandards and that a
copy gfthis record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. Yen may also attach additional pages ifnecessary.
SUBMITTAL INSTUCTIONS
24a. For All shells: Submit this form within 30 days of completion of well
construction to the following:
(ft.) Division of Water Quality, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borebole diameter: (in.) 241). For Iniection Wells: In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 clays of completion of well
12. Well construction method: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 Mail Service Center, Raleigh, NC 27699-1636
13a. Yield (gilm) Method of test: 24c. For Water Supply & Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the comity
where constructed.
Form GW-t North Carolina Department of Environment and Nattual Resources - Division of Water Quality Revised Jan. 2013

WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
VINCE FEDERLE
Well Contractor Name _...
A - 3552
NC Well Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Company Name
2. Well Construction Permit!/:
List all applicable well comiruction permits (i.e. County, State, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Ileating/Cooling Supply)
❑Industrial/Commercial
❑Municipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
❑irrl atlon
Non -Water Supply Well:
❑Monitoring ❑Recovery
❑Aquifer Recharge
❑Aquifer Storage and Recovery
❑Aquifer Test
❑Experimental Technology
❑Geothermal (Closed Loop)
❑Geothermal (Heating/Cooling
❑Groundwater Remediation
❑Salinity Barrier
❑Stormwater Drainage
❑Subsidence Control
❑Tracer
❑Other (explain under 921 I
4. Date Well(s) Completed: 05/04/15 Well ID# MW-14
5a. Well Location:
USPS
Facility/Owner Name Facility ID# (if applicable)
3701 WEST WENDOVER AVENUE GREENSBORO 27407
Physical Address, City, and Zip
GUILFORD
Comity
Parcel Identification No. (PIN)
5b. Latitude and Longitude in degrees/minutes/seconds or decinull degrees
(ifwell field, one lat/long is sufficient)
360 03' 26.24" N 790 52' 30.32"
6. Is (are) the well(s): ©Permanent or ❑Temporary
7. Is this it repair to an existing well: ❑Yes or R)No
I1'11ds is a repair, fill out known well construction in/bri nation and explain the nature of7he
repair under 1121 remarks section at, on the back of 1his foruh.
1
For Internal Use ONLY:
14. WATER ZONES
FROM
TO
DESCRIPTION
f't.
I ft.
LINE R if a t lichblc
15: OUTER CASING iiir multi -cased wells) oRTER
FROM
TO
DIAME'R
' CKNE55
MATERIAL,
ft.
I ft.
I ill.
16. INNER CASING OR
TUBING eothernriil`closed-loop)'
FROM
'I'O1
DIAMETER
THICKNESS
MATERIAL
0.0 ft'
15.0 ft•
2.0 in.
SCH 40
PVC
ft.
I ft.
in.
17 SCREEN
FROM
TO
WAMETER
I SLOTSIZC
I THICKNESS
MATERIAL
15.0 "'
30.0 ft.
2.0 "''
.010
SCH 40
PVC
ft.
ft.
in•
7& GROUT
FROM
f0
MATERIAL
EMIPLACEMEN'I'AIETIIOD&ANIOUN"r
0.0 ft.
11.0 ft.
PORTI NDDENTONITE
SLURRY
ft.
et,
19. SAND/GRAVEL PACK (if a t rlicable
FROM
TO
MA•I'ERIAL
EMPLACEMENTMETHOD
13.0 ft.
30.0 ft.
20-40
FINE SILICA SAND
ft.
ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM
TO
DESCRIPTION (culor, hardness, suiVrocic type, grain size, etc.)
0.0 ft'
1.0 ft'
CONCRETE
1.0 f`
5.0 ft•
GRAVEL
5.0 ft.
30.0 ft.
RED/BROWN SANDY CLAYEY SILT
ft.
ft.
ft.
ft.
ft.
fr.
ft.
ft.
21. REINIARKS
BENTONITE SEAL FROM 11.0 TO 13.0 FEET
22. Certification:
05/19/15
Signature oCCertified Well Contractor Date
fIp .signing this form, 1 hereby certify that the trel7(sJ was (here) constructed in accordance
with 15A NCAC 02C .0100 or I5A NCAC 02C .0200 Well Constniction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
9. Number of wells constructed: construction details. You may also attach additional pages if necessary.
hor nnrltiple it(jection or non -water supply wells ONLY with the sane construction, you can
subunit one faun. SUBMITTAL INSTUCTIONS
9. Total well depth below land surface: 30.0 (ft,) 24a. For All Wells: Submit this form within 30 days of completion of well
Par nn ltiple wells list all depths if'clJjerent (evanhple- .3@200' and 2@100') construction to the following:
10. Static water level below to of casing: 24.0 Division of Water Quality, Information Processing Unit,
P � (I�t•) Q yt g
Iflrater level is above casing, use "+" 1617 Mail Service Center, Raleigh, NC 27699-1617
11. Borehole diameter: 8.0 (in.) 24b. For Injection Wells: In addition to sending the form to the address in 24a
AUGER above, also submit a copy of this form within 30 clays of completion of well
12. Well construction rnethorl: construction to the following:
(i.e. auger, rotary, cable, direct push, etc.)
Division of Water Quality, Underground Injection Control Program,
FOR WATER SUPPLY WELLS ONLY: 1636 (flail Service Center, Raleigh, NC 27699-1636
13a. Yield (gpm) Alethod of test: 24c. For Water Supply c& Iniection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
13b. Disinfection type: Amount: completion of well construction to the county health department of the County
where constructed.
Form GW-I North Carolina Department of Environment and Natural Resources - Division of Water Quality Revised Jan. 2013

Notice of Intent to Construct or Operate Injection Wells
United States Postal Service — Bulk Mail Center, Greensboro, North Carolina
APPENDIX B
MSDS FORM
�ATC
E>tE�RONMEN1AL • OEUMMICAL
N1111GISG iE1UM • WIMILMSI N6

;w,.
BIQ-CAT
Microbials
Form: Powder
Safety Data Sheet
Section 1: Identification
Product Identifier:
EnviroBac
Other Identifier:
NONE
Recommended Use:
See Product Literature
Supplier Information:
689 Canterbury Rd
Shakopee, MN 55379
(p)952-445-4251 (f) 952-445-7233
[e-mail]
Emeraencv Phone:
434-589-4777 8am - 4Dm EST
I Section 2: Hazard Identification I
Hazard Classification:
Eye Damage/Irritation Category 2B
Skin Corrosion/Irritation Category 2
Signal Word: Warning
Hazard Statements:
H315 Causes skin irritation.
H320 Causes eye irritation.
I
Pictogram(s): r
Precautionary Statement(s):
P264 Wash face and hands thoroughly after handling.
P280 Wear protective gloves/protective clothing/eye protection/face protection.
Response Statement(s):
P302/352 IF ON SKIN: Wash with plenty of water.
P305/351 /338 IF IN EYES: Rinse cautiously with water for several minutes. Remove contact
lenses, if present and easy to do. Continue rinsing. Immediately call a poison center/doctor.
P308/31 1 IF exposed or concerned: call a poison center/doctor.
P332/313 If irritation occurs: get medical advice/attention.
P337/313 If eye irritation persists: get medical advice/attention.
P362/364 Take off contaminated clothing and wash it before reuse.
Hazards Not Otherwise Categorized:
Moderate Resoiratory Irritant
Section 3: Composition/ Information on Ingredients
Name: Proprietary bacterial blend CAS Number: N/A %by weight: 3.5-6%
Name: Maltodextrin CAS Number: 9050-36-3 %by weight: 2-3.5%
Name: Sodium chloride CAS Number: 7647-14-5 %by weight: Remainder %
Section 4: First -Aid Measures
Inhalation: If inhaled remove from contaminated area to fresh air. Report the situation. Seek
medical attention if allergic response is exhibited.
Page 1 of 3

;w,.
BIQ-CAT
Microbials
Eye Contact: In case of contact with eyes, flush eyes with low pressure water for at least 15 minutes.
If irritation develops, seek medical attention.
Skin Contact: In case of contact with skin, wash skin with soap and cold water. Remove
contaminated clothing and wash.
Ingestion: If swallowed, rinse mouth and throat thoroughly with tap water. Drink water.
Section 5: Fire -Fighting Measures
Suitable Extinguishing Media: Standard procedure for chemical fires. Foam. Water.
Non -Suitable Extinguishing Media: None
Specific Exposure Hazards: None
Protective Eauipment: No special reauirements
Section 6: Accidental Release Measures
Personal precautions, Use only with adequate ventilation/personal protection. Avoid breathing
Emergency Procedures: dust or spray mist. Avoid formation of dust and aerosols. (See section 8).
Containment methods: Prevent further leakage or spillage if safe to do so.
Cleanup Procedures: Contain and remove spilled product by mechanical means or with a
vacuum cleaner equipped with a high efficiency filter. Avoid formation
of aerosol.
Section 7: Handling and Storage
Safe Handling: Never handle powder without appropriate personal protective
equipment in accordance with Section 8. Avoid formation of dust.
Avoid splashing and high pressure washing. Ensure good ventilation of
the room when handling this product.
Storage: Keep container tightly closed in a cool, dry, well ventilated place.
Section 8: Exposure Controls/Personal Protection
Appropriate engineering controls: Adequate ventilation required for dusty conditions
Eye/face protection: Wear protective glasses or eye shield
Skin protection: Impermeable gloves recommended
Respiratory Protection: Use NIOSH approved respiratory rotection such as full face mask
Section 9: Physical and Chemical Properties
Appearance:
Odor:
Odor Threshold:
pH:
Melting point/freezing point:
Initial boiling point and boiling range:
Flash point:
Light to dark tan colored powder
Characteristic fermentation odor
Not available
Not available
Not available
Not available
Not available
Evaporation rate:
Not available
Flammability (solid, gas):
Not available
Upper/lower flammability or explosive limits: Not available
Vapor Pressure:
Not available
Vapor Density:
Not available
Relative Density:
Not available
Solubility:
Soluble
Partition coefficient: n-octonol/water:
Not available
Auto -ignition temperature:
Not available
Decomposition temperature:
Not available
Viscosity:
Not available
Page 2 of 3

;W'-
B10-CAT
Microbials
Section 10: Stability and Reactivity
Reactivity:
Not available
Chemical Stability:
Stable under normal storage conditions
Hazardous reactions:
Not available
Conditions to avoid:
Not available
Incompatible materials:
Not available
Hazardous Decomposition Products: Not available
Section 11: Toxicological Information
Routes of Exposure:
Eye contact, skin contact, ingestion, inhalation
Symptoms:
Immediate:
Delayed:
Acute toxicity:
Eye Irritation:
Skin Irritation:
Respiratory Irritation:
Sensitization towards product:
Germ cell mutagenicity:
Reproductive toxicity:
Carcinoqenicitv:
May cause irritation to the eyes, skin, mucus membranes, and the
upper respiratory tract
Not available
Not available
May cause minor irritation
May cause minor irritation
May cause minor irritation
There is no evidence of sensitizing potential
Not available
Not expected to produce reproductive toxicity
Not classified as a carcinogen by IARC, OSHA, or NTP
Section 12: Ecological Information
Ecotoxicity:
Not available
Persistence and degradability:
Product is readily biodegradable
Bioaccumulative potential:
Not available
Mobility in soil:
Not available
Other adverse effects:
Not available
Section 13: Disposal Considerations
No special disposal method required, except that in accordance to all applicable federal, state, and
local regulations.
Section 14: Transport Information
Harmonized Tariff Code:
3002.90.10 (for Microbials)
UN Number:
Not classified
UN Proper Shipping Name:
Not classified
Transportation Hazard Class:
Not classified
Packing Group:
Not classified
Transport Environmental Hazard:
Not classified
Transport Special Precautions:
Not classified
MARPOL:
Not classified
Section 15: Regulatory Information
All components of this product are
listed or exempt from listina on the TSCA Inventorv.
Section 1 b: Other Information
Revision History: Effective Date: 04/25/17 Supersedes: First Issue GHS 2015 FORMAT
The information contained in this Safety Data Sheet, as of the issue date, is believed to be true and correct. However, the
accuracy or completeness of this information and any recommendations or suggestions are made without warranty or
guarantee. Since the conditions of use are beyond the control of the company, it is the responsibility of the user to determine
the conditions of safe use of this product. The information does not represent analytical specifications. END OF SIDS
Page 3 of 3