WI0400553_Permit (Issuance)_20200729

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 individualpermit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to injection)
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 .02251 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.
5) In -Situ Thermal Wells (IST) — Used to `heat' contaminated groundwater to enhance remediation.
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: , 20 PERMIT NO. W 10400553 (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.
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) Small -Scale Injection Operation ...................... Complete sections B through M
(5) XXXXX Pilot Test ................................................. Complete sections B through M
(6) Tracer Injection Well ................................... Complete sections B through M
(7) In -Situ Thermal (IST) Well ........................... Complete sections B through M
B. STATUS OF WELL OWNER: State Government
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 1

C. 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): NCDEQ, DWM, UST Section -Federal & State Lead Program (TF# 30236) Mailing
Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: WAKE
Day Tele No.: 919-707-8166 Cell No.:
EMAIL Address: Sharon.Ghiold(a-)ncdenr.gov Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Harold Reynolds, Property Owner
Company Name N/A
Mailing Address: 3900 McConnell Road
919-571-4718
City: Greensboro State: �NC_ Zip Code: 27406 County: Guilford
Day Tele No.: 336-707-3907 Cell No.: N/A
EMAIL Address: N/A Fax No.: N/A
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
F.
G.
Name and Title: Kevin Buchanan
Company Name WithersRavenel, Inc.
Mailing Address: 115 MacKenan Drive
City: Cary State: NC Zip Code: 27511 County: WAKE
Day Tele No.: 919-469-3340 Cell No.: 919-422-1141
EMAIL Address: kbuchanan&withersravenel.com
PHYSICAL LOCATION OF WELL SITE
Fax No.: 919-467-6008
(1) Facility Name & Address: (Former) Caviness Grocery
3904 McConnell Road
City: Greensboro County: Guilford Zip Code: 27405
(2) Geographic Coordinates: Latitude": " or °
Longitude": ° if or °
Reference Datum: Accuracy:
Method of Collection:
"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: 4,000 square feet
Land surface area of inj. well network: < 500 square feet (< 10,000 W for small-scale injections)
Percent of contaminant plume area to be treated: —10% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 2

H.
I.
J.
K.
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.
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:
Pumose: Reduction of Gross Contaminant Level concentrations of petroleum compounds.
Scope: Injection of Re,genesis PersulfOx through GeoProbe tooling into a total of seven (7) injection points
with target volumes of 450 gallons point (gpprox. 3,150 gallons total injection volume)
WELL CONSTRUCTION DATA
(1) No. of injection wells: Proposed Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 25-40
(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
INJECTION SUMMARY
NOTE: Onlv iniectants annroved by the enidemiologv section of the NC Division ofPublic Health. Department
of Health and Human Services can be infected. Approved iniectants can be found online at
http:Hdeg.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/ground-water-approved-injectants. All other substances must be reviewed by the DHHSprior to use.
Contact the UIC Program for more info if you wish to get approval° or a different additive. However, please
note it may take 3 months or longer. If no iniectants are to be used use N/A.
Injectant: Regenesis PersulfOx Total Amt. to be injected (gal)/event: 3,150
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev. 2-17-2020 Page 3

Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/
Total Amt. to be injected (gal/event):
150
No. of separate injection events: I Total Amt. to be injected (gal): 3,150
Source of Water (if applicable): City of Greensboro Municipal Supply
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.
After completion of pilot scale injection, WR proposes a groundwater sampling event at the site after three -
weeks' time to determine whether the injection of material has had the desired effect (e.g., reduction of petroleum
contaminants in smear zone and groundwater of the site). Based on results of pilot scale injection, WR will
recommend a full-scale injection event at the facility.
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, I 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 I5A NCAC 02C 0200 Rules. "
Kevin B. Buchanan, Project Manager, WithersRavenel,
on behalf of NCDEQ-DWM, UST Section for TF#30236
Signature of Applicant Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) 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 well(s) conform to the Well Construction Standards
(I SA NCAC 02C C. 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.
SEE ATTACHED NCDEQ STATE -LEAD ACCESS AGREEMENT FOR PROPERTY
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. 2-17-2020 Page 4

Sharon Ghiold
DWM UST Section
1637 Mail Service Ctr
Raleigh, NC 27699-163 7
Dear Ms. Ghiold:
RE: Site Access Agreement
Caviness Grocery
3904 McConnell Road
Greensboro, Guilford Codnty,�NC— % WSRO ,z t .. `-
incident #30236
Risk/Rank: High H260D
2015 SP 14 Pr l 3: 1
I am/We are the owner(s) of a paictl Of property, localiiil at or near the incident in question,
and hereby permit the Department of Environment and Natural Resources (Department) or its
contractor to enter upon said property for the purpose of conducting an investigation of the
groundwaters under the authority of G.S. 143-215.3(a)2.
I am/We are granting permission with the understanding that:
The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction, ,and maintp►ance ctf the site and access shall be borne by the
Department or its contractor. The Department or. its contractor shall protect and prevent damage
to the surrounding lands.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the
shortest feasible route t6 the nearest public'road. ',Thc Department or its contractor may enter
upon the land at reasonable times and have full right of access during the period of the
investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article
31 of Chapter 143 of the North 'Carolina General Statutes, Tort Claims Against State
Departments and Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon
request and is a public record, in accordance with G.S. 132-1.
6. The activities to be carried out by the Department or its contractor are for the primary benefit
of the Department and of the State of North Carolina. Any benefits accruing to the owner are
incidental. The Department or its contractor is not and shall not be construed to be an agent,
employee, or contractor of the land owner.

Caviness Grocery
STF #30236
Page 2
I/We agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's wells) and equipment during the investigation.
Signatur
R FV"-49
Type/Print Name of Own or Agent
Phone Number
Address
/!"t 2-74406
City/State/Zip Code
9-g --A d1.s
Date

%0 WithersRavenel
NoOur People. Your Success.
WELL CONSTRUCTION LOG
Boring ID: TBD MW-1 Job Name: Caviness Grocery Job #: 02170214.09
Date: July 21, 2020 Site Loc.: Greensboro, NC
WR Rep: Matthew James Driller: SAEDACCO, Inc. NC Well Contractor #: 1947
Depth in
Soil Description
Proposed Injection Point (Typical)
Feet
(Field USCS Classification)
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Ground Surface
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Notes: GeoProbe DPT Boring (Typical)
1.) Boring to be terminated at 40' BLS
2.) BLS - Below Land Surface = = Historical Groundwater Level (Measured Beneath BLS)
Page 1 of 1
ii5 MacKenan Drive Cary, North Carolina 27511 tel.919.469.334o f8x.919.467.6008 www.withersravenel.com

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Engineers I Planners I Surveyors GREENSBORO,GUILFORUILFORDCOUNTY, NC APPROVED BY: DATE: PROJECTNO.:
115 MacKenan Drivel Cary, NC 27511It: 919.469.3340I license#: C-0832I—withemravenel.com GENERAL LOCATION MAP SMB 12/11/17 02170214.09
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FORMER PUMP ISLAND
FORMER UST AREA
{UST #1 & #2)
GRAPHIC SCALE
0 5 10 20
1 inch = 10 Ft,
LEGEND
TYPE II MONITORING WELL
NOTES-
1.) 2014 AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT,
uum
FORMER UST AREA
(UST #3)
�I
I 1
III
f ! I
1 J I
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MW-3R f I
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FORMER PUMP ISLAND
A• MW-2R -
Il
(BDL* l� 1 fl 2 -
1 �
FORMER UST AREA _
(UST #1 & #2)
FORMER CAVINESS
GROCERY
GRAPHIC SCALE
0 5 10 20
1 inch = 10 ft.
LEGEND
TYPE 11 MONITORING WELL
(23,210)
TOTAL BTEX CONCENTRATION (uglL) - OW28116
(1,138')
TOTAL BTEX CONCENTRATION (uglL) - 01104
(BDL..)
NO BTEX COMPOUNDS DETECTED ABOVE
LABORATORY METHOD DETECTION LIMITS-12l22115
NOTES:
1. 2014 AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT-
2. ESTIMATED EXTENT OF TOTAL BTEX IN GROUNDWATER INCLUDES ANALYTICAL
DATA FOR SAMPLES OBTAINED ON 0942&16 (MW-1RR AND MW-V),12f9,21S5
[MW-M AND 061211H (MW-4).
Aom
(19,660)
MW-1RR
f
(23,2301�
MW-3R
ESTIMATED EXTENT OF
BENZENE AT CONCENTRATIONS
EXCEEDING GCL
ESTIMATED EXTENT OF
TOTAL BTEX IN
� GROUNDWATER
FORMER UST AREA
1 � -7 (UST#3)
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ESTiMATED EXTENT OF
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B EXCEEDING GCL
ESTIMATED EHTENTOF
- TOTAL BTEX IN
(19,660) GROUNDWATER
L~ L
MW-1RR
FORMERUSTAREA
(UST 41 & #2)
FORMER UST AREA
LEGEND
- - - (UST#3)
TYPE II MONITORING WELL
1 +
3
1
(23,210) TOTAL BTEX CONCENTRATION (uglL) - 09128/15
(23,210
f +
(1,138') TOTAL BTEX CONCENTRATION (uglL) - 8l21104
MW-3R�
(BDL") NO BTEX COMPOUNDS DETECTED ABOVE NESS
i A'
LABORATORY METHOD DETECTION LIMITS-12122115
H
NOTES:
M W-4
1. 2014 AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT.
1
(1,138`)
2. ESTIMATED EXTENT OF TOTAL STEX IN GROUNDWATER INCLUDES ANALYTICAL
DATA FOR SAMPLES OBTAINED ON OW8116 (MW-1 RR AND MW-3R),12122115
IMW-2Rj AND 08121M4 {MW-0).
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09/28/16(MM W-IRR-W 3R)
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Remedial Cost Proposal
To: Withers & Ravenel
From: Andy Lowy - Design Specialist
[e-mail]
Subject: Design and Cost Estimate
Site: Caviness Grocery
Greensboro, NC
Location: MW-1RR
Applicable Product
PersulfOx®
0 REGENESIS
[phone]
Link to View/Download Product Information
PersulfOx
1/24/2020
REGENESIS is pleased to present you with this design and cost estimate for the proposed treatment at your site utilizing
the remediation technologies presented above. Included within this document you will find the following attachments
supporting the proposed approach:
• Map Depicting Treatment Area
• Remedial Design and Cost Estimate
• Product Technical Sheet
• Standard Assumptions
• Terms and Conditions
Remedial Approach
Regenesis is recommending one application of PersulfOx to chemically oxidize and reduce petroleum mass in MW-1RR as
a pilot test. We recommend taking a baseline sample prior to the application and then monthly sampling afterwards for at
least the first three months post application.

1UEDAe'&
Drilling - Direct Push - Remediatian Services
9088 Northfield Drive
Fort Mill, South Carolina 29707
Phone: [phone] / Fax: [phone]
www.saedacco.com
PrgnoSal
Withers & Ravenel - Cary RE: Former Caviness Grocery - MW-1 RR Core Area
115 MacKenan Drive 3904 McConnell Rd.
Cary, NC 27511 Greensboro, NC 27301
Phone: [phone] / Fax: Guilford County
Email: [e-mail]
ATTN: Matt James FROM: Jack Byer ([e-mail])
Project Date: 1/24/2020
Last Revised Date: 1/24/2020
Job Number: 20200124-1619
description / Unit Quantity Rate Extension
Scope of Work : Injection of client provided products at 7 injection points (2-4 GPM with a target volume of
450 gallons/point (MW-1RR Core Area) -approximately 3,150 gallon total injection volume). SAEDACCO will provide
all required tanks, pumps, injection tooling and a Geoprobe 7822 DPT rig. No water is available on -site.
TRAVEL:
Mobilization, each 1 $550.00 $550.00
Per Diem - 3-Man Crew, per day 3 $375.00 $1,125.00
DECONTAMINATION:
Steam Cleaner, per day
3
$75.00
Included
Decontamination, lump sum
1
$200.00
$200.00
GEOPROBE SERVICES:
DPT Track Rig & Crew, per day
3
$1,600.00
$4,800.00
Mixing, Batching & Blending System, per day
3
$450.00
$1,350.00
Grout Abandon DPT Boring, per ft.
280
$2.00
Included
OTHER:
Water Supply (tanks, pumps, fittings & hoses), per day
3
$50.00
$150.00
Miscellaneous Tools & Equipment, per day
3
$75.00
$225.00
Water Supply, per day
3
$100.00
$300.00
Total Estimated Cost: $8,700.00
Time Estimate - 3 Days
Proposal/Project Notes:
1. Client to provide all required permits for injection project.
2. If deemed necessary, client to provide temporary fencing to secure work area.
3. Proposed costs assumes that a water supply location is available on site. SAEDACCO will transport water to
the work area. If a permit and fire hydrant connection is needed, SAEDACCO can procure and will pass through
expenses related to obtaining the water source.
4. SAEDACCO does not warrant the effectiveness of the injection process and has relied on information provided
by client in preparation of the estimate.
ACCEPTANCE: SAEDACCO:
Name / Title: Name / Title:
Date: Date:
P.O. Number:

SAEDACCO is not liable for any damage to any underground property or utilities as long as the drilling is done at the location indicated by Client field
representative and SAEDACCO has not been contracted to locate underground utilities and/or structures. Also, SAEDACCO will not obtain and is not
responsible for obtaining any required regulatory well permits unless specially contracted to do so. Client must provide all required well permits before
drilling can commence.
Monthly Invoices are due and payable on receipt in U.S. dollars. Invoices not paid within 30 days of date of invoice are subject to an interest charge of
one and one-half percent (1.5%) on the outstanding balance for each month or portion thereof beyond the thirty day period.

12
4/
2
030 � REGENESIS
Assumptions
In generating this design proposal REGENESIS relied upon professional judgment and site specific information provided by
others. Using this information as input, we performed calculations based upon known chemical and geologic relationships
to generate an estimate of the mass of product and subsurface placement required to affect remediation of the site. The
attached design summary tables specify the assumptions used in preparation of this technical design. We request that
these modeling input assumptions be verified by your firm.
REGENESIS developed this Scope of Work in reliance upon the data and professional judgments provided by those whom
completed the earlier environmental site assessment(s). The fees and charges associated with the Scope of Work were
generated through REGENESIS' proprietary formulas and thus may not conform to billing guidelines, constraints or other
limits on fees. REGENESIS does not seek reimbursement directly from any government agency or any governmental
reimbursement fund (the "Government"). In any circumstance where REGENESIS may serve as a supplier or subcontractor
to an entity which seeks reimbursement from the Government for all or part of the services performed or products
provided by REGENESIS, it is the sole responsibility of the entity seeking reimbursement to ensure the Scope of Work and
associated charges are in compliance with and acceptable to the Government prior to submission. When serving as a
supplier or subcontractor to an entity which seeks reimbursement from the Government, REGENESIS does not knowingly
present or cause to be presented any claim for payment to the Government.
Closing
Please feel free to contact me if you need additional information or have any questions regarding our evaluation and/or
this correspondence (contact info listed above). Thank you for considering REGENESIS as part or your remedial solution for
this project.
Page 2 of 2

FORMER PUMP ISLAND
A• MW-2R -
Il
(BDL* l� 1 fl 2 -
1 �
FORMER UST AREA _
(UST #1 & #2)
FORMER CAVINESS
GROCERY
GRAPHIC SCALE
0 5 10 20
1 inch = 10 ft.
LEGEND
TYPE 11 MONITORING WELL
(23,210)
TOTAL BTEX CONCENTRATION (uglL) - OW28116
(1,138')
TOTAL BTEX CONCENTRATION (uglL) - 01104
(BDL..)
NO BTEX COMPOUNDS DETECTED ABOVE
LABORATORY METHOD DETECTION LIMITS-12l22115
NOTES:
1. 2014 AERIAL OBTAINED FROM THE LOCAL COUNTY GIS DEPARTMENT-
2. ESTIMATED EXTENT OF TOTAL BTEX IN GROUNDWATER INCLUDES ANALYTICAL
DATA FOR SAMPLES OBTAINED ON 0942&16 (MW-1RR AND MW-V),12f9,21S5
[MW-M AND 061211H (MW-4).
Aom
(19,660)
MW-1RR
f
(23,2301�
MW-3R
ESTIMATED EXTENT OF
BENZENE AT CONCENTRATIONS
EXCEEDING GCL
ESTIMATED EXTENT OF
TOTAL BTEX IN
� GROUNDWATER
FORMER UST AREA
1 � -7 (UST#3)
1
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r � !
f� f Il
r1
A
1
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LEGEND
TYPE II MON[TOR ING WELL
(23.210) TOTAL BTEX CONCENTRATION (ug1L) - 08/27/19
NOTES:
1 2G14 AERIAL OBTAINED FRGM THE LOCALCOLINTY GIS DEPARTMENT
GRAPHIC SCALE
0 10 20 40
1 inch - 20 R.
ESTIMATED EXTENT OF
TOTAL BTEX IN
FORMER PUMP ISLAND GROUNDWATER
ESTIMATED EXTENT OF
r Y BENZENE AT CONCENTRATIONS
MW-7�R EXCEEDING GCL
(NS) f1 r lr- — x
1L
2 Jf47Oflj
+� xT-MW 3RR
FORMER UST AREA � � I
(UST #1 & #2) X X' X 1
I FORMER UST AREA
(UST #3)
r �
3 l�
(2,618) ' f -3R
I
O MW-4
4 \(37.7)
\ I
r
F r I a
SUMMARY OF GROUNDWATER ANALYTICAL RESULTS
a
6
n
zz
rY
u ti
do
O
N
rl
W
tr
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�
i*
u
❑ g
R
s m
x m
a Y
m $
c
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—A
❑a
~
z
ao
—
V) LL
Jam r
NZa
w a
� S
U a H
R
J LLI
Q m
a
z
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LLI
Analytical Method
6"05l EPA-0260 -Volatile Orpnic
Compounds
Calculated
m
m
2
Sample
Date
m
i
m
10
CA tlected
Ep
L
4
I'.`
e
=
=
c
c
m
i
a
x
gym_
m
a
s
87$8-1
71.43-2
104-51-6
135.9$-9
1
107-0&2
15T20-7
15741-4
551-7&6
S"?-a
T"76
7a-93-3
708.70.t
1634-04-4
51-20.9
JQW. '1
106-88-3
95-0313
t08-S7-8
NA
MW-1RR
W2712019
3500
8.104
100
'L3
96
260
2-0
810
220
1200
1 3W
sr,OW
SW
3W
19,000
2700
180
12,000
M W •2R
8l2712019
MW-M
W712019
11
18
28
V
580
17
T8
11
1,400 35 230
27
130
ow
2,000
MW4
W2712019
37
0.7
NC 2L Standard
t1000
1
70
70
0.02
0.4
70
600
40
70
25,000
25
4000 100
20 6 70
500
400
400
500
MLs. for Groundwater
5,000,000
5,0W
S,t100
SAW
s0
400
70Wa
8+1,i500
WL
_
11,700
4,11M000 100,000
20,000 5,000 30,000
250,000
7%5w
25,000
OS,$00
Noter.
_ z ! I All (estAw RoAdal to WL Imicro0rans per liter) or parts per Billion
21 Compounds analyzed for by laboratwy but nol listed weia not detected above latwratwy detection Irmils. See the laboratory fuwn included in the Aopendix fw a full list of consliluanls.
3) NC 2L Slarxlarrl- Noah Cerdlrna Grmindwalel 4twlily Standard as per NC Adrn mmrati%a Cnde 15A NCAC (12L
4) GCLs for Gmundwater = MCdENR UST Sectim Grass CaMarnl nadm La is for GrourwMwpr
NL = Not Listed
Result = Result Exceeds La6oralory Oatecton Lands
iim" = Result Exceeds 2L Standard
ti = Result Exceeds GCL Vslue

04 REGENESIS
•
-
PersulfOx® Application Design Summary
Caviness Grocery
MW-1RR Core
Field App. Instructions
Greensboro, NC
MW-1RR Core
Application Method Direct Push
Prepared For:
Spacing Within Rows (ft) 7
Withers & Ravenel
Spacing Between Rows (ft) 8
Injection Points (per app.) 7
Target Treatment •
Treatment Area
ft 2
400
Number of Applications 1
Top Treat Depth
ft
25.0
Areal Extent (square ft) 400
Field Mixing Ratios
Bot Treat Depth
ft
40.0
Top Application Depth (ft bgs) 25
Water per Pt per app (gals)
Vertical Treatment Interval
ft
15.0
Bottom Application Depth (ft bgs) 40
407
Treatment Zone Volume
ft3
6,000
PersulfOx to be Applied (Ibs) 5,951
PersulfOx per Pt per app (Ibs)
Treatment Zone Volume
cy
222
PersulfOx Solution % 20%
850
Soil Type
---
silt
Volume Water (gals) 2,852
Total Volume per Pt per app (gals)
Porosity
cm3/cm3
0.40
Total Volume (gals) 3,150
450
Per Application Totals
Effective Porosity cm3/cm3 0.15
Treatment Zone Pore Volume
gals
17,953
PersulfOx per app. (Ibs) 5,951 Volume per vertical ft (gals)
Treatment Zone Effective Pore Volume gals
6,732
Volume Water per app. (gals) 2,852 30
Fraction Organic Carbon (foc)
g/g
0.005
Total Volume per app. (gals) 3,150
Soil Density
g/cm3
1.5
Soil Density
Ib/ft3
94
Technical Notes/Discussion
Soil Weight
Ibs
5.6E+05
Hydraulic Conductivity
ft/day
1.0
Hydraulic Conductivity
cm/sec
3.53E-04
Hydraulic Gradient
ft/ft
0.007
GW Velocity
ft/day
0.05
GW Velocity
ft/yr
17
Sources of Oxidant Demand
Unit
Value
Assumptions/Qualifications
Sorbed Phase Contaminant Mass
Ibs
56
56
Dissolved Phase Contaminant Mass
Ibs
In generating this preliminary estimate, Regenesis relied upon professional judgment and site specific information provided by others. Using
Total Contaminant Mass
Ibs
103
this information as input, we performed calculations based upon known chemical and geologic relationships to generate an estimate of the
mass of product and subsurface placement required to affect remediation of the site.
Stoichiometric PersulfOx Demand
Ibs
3,121
Stoichiometric PersulfOx Required
Ibs
4,682
REGENESIS developed this Scope of Work in reliance upon the data and professional judgments provided by those whom completed the
Additional Soil Oxidant Demand
g/kg
2.0
earlier environmental site assessment(s). The fees and charges associated with the Scope of Work were generated through REGENESIS'
SOD PersulfOx Required
Ibs
1,248
proprietary formulas and thus may not conform to billing guidelines, constraints or other limits on fees. REGENESIS does not seek
Total PersulfOx Required
Ibs
5,930
reimbursement directly from any government agency or any governmental reimbursement fund (the "Government"). In any circumstance
Application Dosing
where REGENESIS may serve as a supplier or subcontractor to an entity which seeks reimbursement from the Government for all or part of
the services performed or products provided by REGENESIS, it is the sole responsibility of the entity seeking reimbursement to ensure the
Scope of Work and associated charges are in compliance with and acceptable to the Government prior to submission. When serving as a
PersulfOx Required
Ibs
5,951
supplier or subcontractor to an entity which seeks reimbursement from the Government, REGENESIS does not knowingly present or cause to
be presented any claim for payment to the Government.
Prepared By: Andy Lowy - Design Specialist
Date: 112412020

Purchasing Information
Caviness Grocery
PersulfOx Required Ibs
PersulfOx Cost
Estimated Tax and Freight
Estimated Tax and Freight Cost*
MW-1RR Core
5,951
$10,414
15%
$1,562
_J, REGENESIS
Currently Available Packaging Options
PersulfOx Package Type*** # of packages Ibs required
55.1 lb poly -lined bag 108 5,951
*Note that the combined tax and freight costs are preliminary estimates only. Please
contact your local sales manager or Customer Service at 949-366-8000 to obtain a shipping
quote. You will be asked to provide a ship -to address and estimated time of delivery. ***Available Package Types are subject to change.

PERSULF oX.
PersulfOx" Technical Description
PersulfOx is an In Situ Chemical Oxidation (ISCO) reagent that destroys
organic contaminants found in groundwater and soil through powerful, yet
controlled, chemical reactions. A sodium persulfate-based technology
(figure 1), PersulfOx employs a patented catalyst to enhance the oxidative
destruction of both hydrocarbons and chlorinated contaminants in the
subsurface.
Typically, sodium persulfate is activated with the addition of heat, chelated
metals, hydrogen peroxide, or base in order to generate sulfate radicals.
These activation processes are inherently complex, costly and can pose
additional health and safety risks. In comparison, PersulfOx is a relatively
safe and easy -to -use ISCO agent with a built-in catalyst which activates the
persulfate component, generating contaminant -destroying free radicals
without the need for the addition of a separate activator. The equation
below shows the net complete oxidation of toluene, a constituent of
gasoline, by PersulfOx:
0'+ 18 Nat 208 + 14 H2O 7 CO2 + SB NaWi
Example of PersulfOx
Na; O O Na'
P1 11
u i
Q 0
FwAt L. =NLm PEAmFAR Olmupa .19CM
For a list of treatable contaminants with the use of PersulfOx, view the Range of Treatable Contaminants Guide
Chemical Composition
• Sodium Persulfate - CAS #7775-27-1
• Sodium Silicate - CAS #1344-09-8
Properties -
• pH - 7 to 11.5 at 25°C
• Appearance - White, free -flowing powder, clear to cloudy when mixed with water
• Odor - Not detectable
• Vapor Pressure - None
• Chemical Hazard Classification - Class 5.1 Oxidizer
Storage and Handling Guidelines IF
Storage
Store locked up
Keep away from heat
Store in a cool, dry place out of direct sunlight
Handling
Minimize dust generation and accumulation
Routine housekeeping should be instituted to
ensure that dust does not accumulate on surfaces

PersulfOx" Technical Description
Storage (continued)
Store in original tightly closed container
Store in a well -ventilated place
Do not store near combustible materials
Store away from incompatible materials
Recommended to store at less than 40°C
Provide appropriate exhaust ventilation in places
where dust is formed
Applications
0
PERSULF Q
Handling (continued)
Avoid mixing with combustibles
Avoid contamination
Keep away from clothing and other combustible
materials
Wear appropriate personal protective equipment
Avoid breathing dust
Avoid contact with eyes, skin, and clothing
Avoid prolonged exposure
Do not taste or swallow
When using, do not eat, drink or smoke
Wear appropriate personal protective equipment
Wash hands thoroughly after handling
Observe good industrial hygiene practices
PersulfOx is mixed with water at a rate of 5% to 20% prior to application.
For most applications, REGENESIS suggests a 10-15% solution. The resulting mixture has viscosity
similar to water.
Injects into formation through direct push injection points, injection wells or other injection delivery systems.
Application instructions for this product are contained here PersulfOx Abnlication Instructions.
Health and Safety
Ak'
Material is relatively safe to handle; however, avoid contact with eyes, skin and clothing. OSHA Level D
personal protection equipment including: vinyl or rubber gloves, eye protection, and dust mask are recommended
when handling this product. Please review the Material Safety Data Sheet for additional storage, usage, and
handling requirements here: PersulfOx SDS.
02015 All rights reserved. Regenesis and PersulfOx® are registered trademarks of Regenesis Bioremedisdon Products. All other trademarks are the property of their respectwe owners.

t E ENE I
In -Situ Aerobic Bioremediation Performance Monitoring
Parameters
Analytical Parameter
Method
Contaminants of Concern
(COC's)
pH
Varies
Meter reading taken in flow -through cell (DO can
also be measured with a Hach kit)
Colorimetric Hach Method or EPA 6000 series
with filtered and unfiltered samples
Dissolved Oxygen (DO)
Oxidation Reduction Potential
(ORP)
Total Fe
Total Mn
Dissolved Fe
Dissolved Mn
Sulfate
EPA 375.3 or EPA 9056
Nitrate
EPA 353.1 or EPA 9056
Total Organic Carbon (TOC)
EPA 415.1 or EPA 9060
Chemical Oxygen Demand
(COD)
EPA 410.1-.2
Biological Oxygen Demand
(BOD)
EPA 5210B
Alkalinity
EPA 310.2
Methane, CO2
ASTM D1945