WI0300440_Permit (Issuance)_20200812

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 I5A 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.
INSITU 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 Ini ection 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: July 24 , 20 20
PERMIT NO. W 10300440
(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) Small -Scale Injection Operation ......................Complete sections B through M
(5) X Pilot Test.................................................Complete sections B through M
(6) In -Situ Thermal (IST) Well ........................... Complete all sections except K
B. STATUS OF WELL OWNER: Business/Organization RECEIVE®
JUL 31 2020
NC DEQ/DWR
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 Central Office 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): _ Bottling Group. LLC, C/O David Patrick, Legal Senior Director
Mailing Address: 1111 Westchester Ave
City: White Plains State: NY_ Zip Code: 10604 County: Westchester
Day Tele No.: 914-767-7107 Cell No.: 914-260-3605
EMAIL Address: David.Patrick(@pepsico.com Fax No.:
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Mr. Niles Miller- Pastor
Company Name New Hol Temple Church
Mailing Address: PO Box 976
City: Gastonia State: NC_ Zip Code: 28053 County: Gaston
Day Tele No.: 704-853-0670 Cell No.: 704-923-3032
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
Name and Title: Erin Greene, Project Manager
Company Name ATC Associates of North Carolina, P.C.
Mailing Address: 7606 Whitehall Executive Center Drive. Suite 800
City: Charlotte State: NC_ Zip Code: 28273 County: Mecklenburg
Day Tele No.: 704-529-3200 Cell No.: 704-817-0896
EMAIL Address: erin.ureenefibatces.com Fax No.: 704-529-3272
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former Pepsi Bottling Facility
1462 West Airline Ave
City: Gastonia County. Gaston Zip Code: 28052
(2) Geographic Coordinates: Latitude": 0 —"or 35.26308311N
Longitude": 0
If
or 81.20809811 W
Reference Datum: NA Accuracy: NA
Method of Collection: Google Earth
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: 2,400 square feet
Land surface area of inj. well network: square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 5% (must be < 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOI Rev. 2-14-2020 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.
L 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 apply Enviro-BAC (a proprietary bacterial blend) in monitoring wells MW-1 R and MW-7R to promote.
accelerated petroleum compound biodegradation and reduce compound concentrations to below the North
Carolina Groundwater Quality Gross Contamination Levels (GCLs). For each well, one kilogram of Enviro-
BAC will be prepared in a concentrated powder form, mixed with a provided sucrose additive and approximately_
5 gallons of fresh water, then gravity -fed into the well. An additional five to ten gallons of fresh water will be
applied into each well to promote dispersion of the solution into the aquifer. This solution will deliver a unique
blend of non-pathogenic, non -genetically modified microbial organisms to facilitate the bioremediation in
groundwater.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: _ _ Proposed 2 Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): 30-45 ft
(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
K. INJECTION SUMMARY
NOTE: OnN iniectants anoroved by the epidemiolojn: section of the NC Division ofPublic Health, Department
of Health and Human Services can be injected. Approved in ectants can be found online at
hqp://deg.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/Uound-water-approved-iniectants. All other substances must be reviewed by the DHHS prior to use.
Contact the UIC Projeram for more info il'vou wish to -eet approval for a different additive. However, please
note it mat• take 3 months or longer
Injectant:EnviroBAC mixture and sucrose Total Amt. to be injected (gal)/event: 2 Kg
Injectant: Total Amt. to be injected (gal)/event:
Injectant: Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOI Rev, 2-14-2020 Page 3

AmL - Water to be injected (gal/event): 3.0 gal
Total Amt. to be fhie;.t.qd..(jWqVent). 30 gal
No. of separate 16jection 'evejits:._U_N T6tsl AWt. to be injected (gal): UNK
K_Est. . . .
Source ofWaref(ffappjiqable):-Muntein.9i:water from .,Me.6kleiibut-&County-
L. MONITORING PLAN -­Descflbe below or is separate attaohm;-,fit-u monitori0g plan to be used to determine
if violations of groundwater quality standards spe pified in 5ubqhaqk-r_.9A result from the injection activity.
Am= 'makly-, .3Q : dW 4 �Ldr the Jnicdon event, ATt will neo g lipiitd gr6un4dwg1qr a ling event bf
lA
monjL6jrngells' KW-1RMW-5,MW6,1,.Wand M-W-14R and analyze for yolatil,, &&i iic Gommnds by EPA
'bLl�o meas hod 6200B., ATQ'will.g1r, and repofd The field R . arneters.
1VL SIGNATURE OF APPLICANT ANDPROPERTY OWNER
Well gw�rA ' ' lj!9_m_U- "I :hereby. cef tihi under penalty of law., that 1 am. familiar with the information
submitted- t' - nquiry du
bmitted and all altaeknents thereto and that, based on my i of those individuals
Anniddiately responsible for obtaining said information, I believe that the information -is true, accurate and
p
complete. tam aware that there ore sisnificontpenalties, including the posstbility-offines and imprisonment,
fbi- submitting false htfonnation. I agree to construct,. operate, maintain, repair; and:ftpplicable, abandon the
'M -in accordance moth the 114
INVon well acidd ces &CAC: 02-C 6200 Mules.
gignatum'KAppikait Print or Type Full Name and Ti
Pro Jifthd pea vis-not owned. b -ner/Applicant):*
y the OW
-it), and operated, 1hereb-pe consent .A owner ofthoproperty.on.which.ihe o -ent to
allow the applicant, io,cbmiructeach ip)ection*elll-.asoi4linedinthis-application andagree.thal i1shall.bethe
responsibility of the applicant to ensure that the injection well(s) coqprm to the Well Construction Standards
'0
5A NCAC - Q2CQM A lf
"Ownpeptntmt 44ypprson who. holds the fee :or. -other property rights in the well being constructed, A well
is real property and its construction on land7 shall be deeined to Vest ownership in. the land owner, in the
bg ­ "V.' - writing.,
a et e of con mry.agreemont. in - /
Ile
4ijnituve* ofpiqpqiiy. bwne'lr (if "JifTeren't-from applicant) Pkink or Type'Fall Name and Title
*An aceos agr4ginenj between the pppitcantpodprope;-ty owner May bg submitted In fi4t ofasignaiiure on this form.
Plesso Bend 1.(4qq)--:bM4.rol4r copy ofthis-NOI-along with:a copy on awattacbed CD.ar Flash Drive. at least
two (2) weeks: prior to. in*don to:
Mau' Service. Center
Xoleigfi, NC-2769.9-1636
Tdliphone: [phone]
Detmed Peimined GW Remedlation NO[ Rev. 2-14-2020 Page 4

Legend
UNDEVELOPED
GRASS �J
Q i
0
i
i
MW-20
MW-12
GRASS
GRASS / ///T
_`� YEL MW-20MW-12 FORMER
NS NS OFFICE & MANUFACTURING
/ RESIDENTIAL
- L
ROSEWOOD �N--____- -- — -- —----------
E
.....................
MW-16 j �\ - _.._.._.._..
MW-17R
NS
Anticipate invoicing late August 2020
MW-17R
W ASPHALT
\1 j Z
IJ ;� �.MW-15 MW-15
NS
MW-5
81.9 MW-21
�. 205 BDL MW-21 �r
83.2
414 ;
1,160 FORMER i
G REHOUSE /
50.3 5,000 ug/L
♦ <2.3
i W-7R 50 ug/L
GRASS ♦ MW- i
MW-7R
7,180
i 11,500
MW 3 MW-1R ;� 1,300
-Q MW-13 �' MW-1R 7,830
Z/,V NS
F 9,680 i 11,700
F 24,100 �Fi 866
1,360
�'� 267* MW-14R
ASPHALT �''�.•\ 12,300 /�
1,770 i• MW-19
MW-14R 343
<0.24 305" MW-19
0.84 •�
NS
<0.24 -_-
�qi� 2.9
�0 <0 44 GRASS
q0
<0.26 '
<0.23
MW-18
0—
ASPHALT
MW-18
NS
GRASS
ASPHALT
GRASS
GRASS
- - - - - - - Property Line
- — — — — — - Adjacent Property Line
---------- Right -of -Way
—■ ■ — Fence Line
----------- Former UST System
Existing Monitoring Well
Benzene Isoconcentration Line
EDB Isoconcentration Line
CaC
2L
GCL
Benzene
1
5,000
Toluene
600
260,000
Ethyl benzene
600
84,500
Xylenes
500
85,500
MTBE
20
20,000
1,2-DCA
0.4
400
EDB
0.02
50
General Notes:
Map adapted from Gaston County CIS & Excel
figure dated 1 /21 /14
Structure locations are approximate
UST - Underground Storage Tank
All concentrations measured in
micrograms per liter (ugA)
Constituent concentrations are based
on samples collected 07/09/19
Data in bold exceeds 21.highlight exceeds GCL
on samples collected 07/09/19
BDL - Below Laboratory Dtection Limits
EDB - Ethylene Dibromide
GCLs - Gross Contamination Levels
NF - Not Found
JF
MkTc
75DO Whitehall 8tecuttve Center Drive, Suite Boo
(Former) Pepsi Facility
1462 West Airline Avenue
Gastonia, Gaston County, NC
Groundwater Analytical Results Map
a,Da:
Bottling Group, LLC
DRAWN BY: DESIGN BY: I CHECKED BY: JAPPROVED BY:
LB TWG I MDS I MDS
1" = 30' 102/28/20201 199PEP1902 4

0
/�� \
»■m o
\ CD % P - k
± \
/ ca $ m �
f 7a 2 N
�2\ k(2
e a £ m 7 ~
2 O
m c \
ƒ / j
a. 'Fa \
r
a))
a
\
k
&
\
G
m
c
.
2
R
\
2
/
d
\
e
k
w ®
0(D
zI#

NQNl►E',j'IIjENTIAL WELLCONSTRUCTTONRECORD
North Carolina Department of Ewbonmad and Natural Resources- Division of Water QnAty
WELL CONTRACTOR CERTIFICATION # 4155
1. WELL CONTRACTOR:
David Brown
Well CarWactor (Individual) Name
Em*cnmental OMng A Probing Se► ICK LLC (EDPS)
Wen Contractor Company Name
STREET ADDRESS 1753E Greenhil Road
Charlotte NC 26278
City ar Town State Zip Code
7p( 4 ), 607 7529 _
Area code- Phone number
2. WELL INFORMATION:
SITE WELL_ ID #(dappkeable MW-7R
STATE WELL PERMIT1WappkaaW)
DWQ or OTHER PERMIT #(if applicable
WELL USE (Check Applicable 800 Monftdng 0 Munfdpdrubkc ❑
Indusbid Commereia(❑ Agricultural ❑ Recovery ❑ In)ediar ❑
irrigation❑ Other ❑ (Est use)
DATE DRILLED--! '—"3
TIME COMPLETED AM ❑ PM ❑
3. WELL LOCATION:
CITYY, Gastona COUNTY Gaston
1462 West Aldine Drive, Geed Is. NC
(Shed Flame. Numbers, Cemmuraty. SuwWor. Lot No., Parcel, Tip Cie)
TOPOGRAPHIC / LAND SETTING:
06kpe OVdiey ®Flat CiRidge ❑ Other
(check app "date boo
LATITUDE j3— m
_ babumdumtere000ds a. sanba
s
LONGITUDE_ _, in a deamai tmmat
La itudenon*tvde source: ❑GPS pTgXW8phie MV
(/ccBWn of mAmust be shown on a USGS tOPO map end
e ached to this form d not usurp GPS)
4.FACILITY-1-0an—(ffi8b4*ecc Am dwwA1A1=%d-
FACILITY ID #(If applicables
NAME OF FACllI'IY Farmer Pepsi n�"
STREET ADDRESS 1462 West AlAine Drive
Gastonia NC
City or TOM State Zip Cade
CONTACT PERSON
MAILING ADDRESS
City or Town state Zip Code
Are�ecod Phone mffd er
0. WELL DETAILS:
a. TOTAL DEPTH: 45 ft
b. DOES WELL. REPLACE EIaSTwe WELL? YES M NO ❑
WATER LEVEL BelowTop of Casing: FT.
(Use'+' If Above Top at Casing)
d. TOP OF CASING IS FT. Above land Surface
Top of casing terminated at/or beloWland surface may require
a variance in accordance v6th 15A NCAC 2C .01 I&
e. YIELD (gpm): METHOD OF TEST
L OWNFECTIOR Type Amount
g. WATER ZONES (depthr
Fran Tc From Tc
Fromm To Fron To
Fran To Fran To
L CASING: Thldoress/
Depttr Dr Ws
Fran To 0 Ft
Fnxn_ To Ft
Fran To Ft
7.OROUT: Depth Mateial Method
From 18 To 16 Ft Beeda3ts Tremle
From^ ToTremis
Frarr—To Ft
& SCREEN: Depth Diameter Slot Size Material
From To 20 R 2 in. 0.01 im PVC
From To Ft in. in.
From To FL__(n is
9. SANDItGRAVEL PACK:
Doh Size Material
FrwL 45 To t8 Ft f&Med Sand
From 7o Ft
From TD Ft
10. DRILLING LOG
From To Formar'an Description
11, REMARKS:
r Do HEREBY CERTFY 1HATTHS WELL WAS COHSTRUCM a ACCORDANCE VAT"
ISANCAC2C.INELLCON57R NST pARDS.AI�THATACCPYaFIM
RECORDHASeI;TAPPCU D U.MN
�J 9110Vi3
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
David- &-6 uto
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit the original to the Division of Water Quality within 30 days. Attn:106"nation Mgt, Form GW-1b
1617 Mail Service Center --Raleigh, NC 276s9-1617 Phone No. [phone] e.V 5SB. Rev. 7105

Form: Powder i
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]
Emer enc Phone:
434-589-4777 8am - 4 m EST
Section 2: Hazard Identification
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.
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 Respiratory 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

Eye Contact:
Skin Contact:
Ingestion
In case of contact with eyes, flush eyes with low pressure water for at least 15 minutes.
If irritation develops, seek medical attention.
In case of contact with skin, wash skin with soap and cold water. Remove
contaminated clothing and wash.
If swallowed, rinse mouth and throat thoroughly with tap water. Drink water.
Suitable Extinguishing Media:
Non -Suitable Extinguishing Media:
Specific Exposure Hazards:
Protective Equipment:
Section 5: Fire -Fighting Measures I
Standard procedure for chemical fires. Foam. Water.
None
None
No sr)ecial
uirements
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 protection such as full face mask
Section 9: Physical and Chemical Properties
Appearance:
Light to dark tan colored powder
Odor:
Characteristic fermentation odor
Odor Threshold:
Not available
pH:
Not available
Melting point/freezing point:
Not available
Initial boiling point and boiling range:
Not available
Flash point:
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

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:
May cause irritation to the eyes, skin, mucus membranes, and the
upper respiratory tract
Delayed:
Not available
Acute toxicity:
Not available
Eye Irritation:
May cause minor irritation
Skin Irritation:
May cause minor irritation
Respiratory Irritation:
May cause minor irritation
Sensitization towards product: There is no evidence of sensitizing potential
Germ cell mutagenicity:
Not available
Reproductive toxicity:
Not expected to produce reproductive toxicity
Carcinogenicity:
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 listing on the TSCA Inventory.
Section 16: 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 SDS
Page 3 of 3

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
Zi
WNW %SR I mn, .
G R O U P
Domino Foods, Inc.
Accwding To Federal Register/Vol 77 %L 58 / Monday, March 26, 2012 / Rules and Regulations and According tthe Hazardous Products Regulation (February 11, 2015)
1.1. Product Identifier
Product Form: Substance
Product Narrl Domino® Extra Fine Granulated, Fruit Granulated, Bakers Special Granulated, Standard Granulated, Medium
Granulated, Medium Fine Granulated, LCMT Granulated Sugar, Sanding No. 2, Superfine, Bottlers' Granulated Sugar, Canners' Extra
Fine Granulated and Con AA Sugar; C&H® Con A Sugar, Con AA Sugar, Coarse Sanding Sugar, Special Sanding Sugar, Con Sanding
Sugar, Special Coarse Sugar, Manufacturers Sugar, Special Grain Sugar, Extra Fine Granulated Sugar, Gel/Fruit Granulated Sugar,
Bottlers Extra Fine Granulated Sugar, Cube Sugar, and Bakers Special Sugar and 35/50 Granulated Sugar; USP/NF and EP grade of
any preceding product.
CAS No: 57-50-1
1.2. Intended Use of the Product
Sweetener
1.3. Name, Address, and Telephone of the Responsible Party
Company
American Sugar Refining Inc.
1 Federal Street
Yonkers, NY 10705
914-963-2400
1.4. Emergency Telephone Number
Emergency Number : 914-963-2400
2.1. Classification of the Substance or Mixture
GHS-US/CA Classification
Comb. Dust
2.2. Label Elements
GHS-US/CA Labeling
Signal Word (GHS-US/CA) Warning
Hazard Statements (GHS-US/CA) May form combustible dust concentrations in air.
Supplemental Information Keep away from heat, hot surfaces, sparks, open flames and other ignition sources. No
smoking. Proper grounding procedures to avoid static electricity should be followed.
Avoid generating dust. Prevent dust accumulation (to minimize explosion hazard).
2.3. Other Hazards
Exposure may aggravate pre-existing eye, skin, or respiratory conditions.
2.4. Unknown Acute Toxicity (GHS-US/CA)
No data available
3.1. Substance
Name Extra Fine Granulated Sugar
CAS No : 57-50-1
Name
Sucrose
Product Identifier
(CAS No) 57-50-1
100
3.2. Mixture
Not applicable
*Percentages are listed in weight by weight percentage (w/w%) for liquid and solid ingredients. Gas ingredients are listed in volume
by volume percentage (v/v%).
4.1. Description of First -aid Measures
1/ t,

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
General: Never give anything by mouth to an unconscious person. If you feel unwell, seek medical advice (show the label where
possible).
Inhalation: Using proper respiratory protection, immediately move the exposed person to fresh air. Obtain medical attention if
breathing difficulty persists.
Skin Contact: Rinse immediately with plenty of water for 5 minutes. Obtain medical attention if irritation develops or persists.
Eye Contact: Rinse cautiously with water for at least 5 minutes. Remove contact lenses, if present and easy to do. Continue rinsing.
Obtain medical attention if redness, pain, or irritation occurs.
ingestion: Rinse mouth. Do not induce vomiting. Get medical advice and attention if you feel unwell.
4.2. Most Important Symptoms and Effects Both Acute and Delayed
General: Not expected to present a significant hazard under anticipated conditions of normal use. Prolonged contact with large
amounts of dust may cause mechanical irritation.
Inhalation: Dust may be harmful or cause irritation.
Skin Contact: Prolonged exposure may cause skin irritation.
Eye Contact: May cause slight irritation to eyes.
Ingestion: Ingestion is not likely to be harmful or have adverse effects.
Chronic Symptoms: Repeated or prolonged contact with skin may cause dermatitis.
4.3. Indication of Any Immediate Medical Attention and Special Treatment Needed
If exposed or concerned, get medical advice and attention. If medical advice is needed, have product container or label at hand.
5.1. Extinguishing Media
Suitable Extinguishing Media: Use extinguishing media appropriate for surrounding fire.
Unsuitable Extinguishing Media: Do not use a heavy water stream. Use of heavy stream of water may spread fire.
5.2. Special Hazards Arising From the Substance or Mixture
Fire Hazard: Combustible Dust.
Explosion Hazard: Dust explosion hazard in air.
Reactivity: Hazardous reactions will not occur under normal conditions.
5.3. Advice for Firefighters
Precautionary Measures Fire: Exercise caution when fighting any chemical fire.
Firefighting Instructions: Use water spray or fog for cooling exposed containers.
Protection During Firefighting: Do not enter fire area without proper protective equipment, including respiratory protection.
Hazardous Combustion Products: Thermal decomposition generates: Carbon oxides (CO, COZ).
Other Information: Risk of dust explosion.
Reference to Other Sections
Refer to Section 9 for flammability properties.
6.1. Personal Precautions, Protective Equipment and Emergency Procedures
General Measures: Avoid prolonged contact with eyes, skin and clothing. Avoid generating dust. Avoid breathing dust. Remove
ignition sources. Keep away from heat, hot surfaces, sparks, open flames, and other ignition sources. No smoking.
6.1.1. For Non -Emergency Personnel
Protective Equipment: Use appropriate personal protective equipment (PPE).
Emergency Procedures: Evacuate unnecessary personnel.
6.1.2. For Emergency Personnel
Protective Equipment: Equip cleanup crew with proper protection.
Emergency Procedures: Upon arrival at the scene, a first responder is expected to recognize the presence of dangerous goods,
protect oneself and the public, secure the area, and call for the assistance of trained personnel as soon as conditions permit.
Ventilate area.
6.2. Environmental Precautions
Prevent entry to sewers and public waters.
6.3. Methods and Materials for Containment and Cleaning Up
For Containment: Contain solid spills with appropriate barriers and prevent migration and entry into sewers or streams. Avoid
generation of dust during clean-up of spills.
2/6

Safety Data Sheet
All White Granulated Sugars
Revision Date 12122/2016 Version 1.0
Methods for Cleaning Up: Clean up spills immediately and dispose of waste safely. Vacuum clean-up is preferred. If sweeping is
required use a dust suppressant. Use explosion proof vacuum during cleanup, with appropriate filter. Do not mix with other
materials. Use only non -sparking tools. Contact competent authorities after a spill.
6.4. Reference to Other Sections
See Section 8 for exposure controls and personal protection and Section 13 for disposal considerations.
7.1. Precautions for Safe Handling
Additional Hazards When Processed: Accumulation and dispersion of dust with an ignition source can cause a combustible dust
explosion. Keep dust levels to a minimum and follow applicable regulations.
Precautions for Safe Handling: Wash hands and other exposed areas with mild soap and water before eating, drinking or smoking
and when leaving work. Avoid prolonged contact with eyes, skin and clothing. Avoid creating or spreading dust. Avoid breathing
dust. Keep away from heat, sparks, open flames, hot surfaces. — No smoking.
Hygiene Measures: Handle in accordance with good industrial hygiene and safety procedures.
7.2. Conditions for Safe Storage, Including Any Incompatibilities
Technical Measures: Comply with applicable regulations. Avoid creating or spreading dust. Use explosion -proof electrical,
ventilating, lighting equipment. Proper grounding procedures to avoid static electricity should be followed.
Storage Conditions: Keep container closed when not in use. Store in a dry, cool place. Keep/Store away from direct sunlight,
extremely high or low temperatures and incompatible materials.
Incompatible Materials: Strong acids, strong bases, strong oxidizers. Sulfuric acid. Nitric acid.
7.3. Specific End Use(s)
Sweetener
8.1. Control Parameters
For substances listed in section 3 that are not listed here, there are no established Exposure limits from the manufacturer, supplier,
importer, or the appropriate advisory agency including: ACGIH (TLV), AIHA (WEEL), NIOSH (REL), OSHA (PEL), Canadian provincial
governments, or the Mexican government.
Sucrose (57-50-1)
Mexico 0 E L TWA (mg/m3) 10 mg/m3
Mexico
0 E L STEL (mg/m3)
20 mg/m3
USA ACGIH
ACGIH TWA (mg/m3)
10 mg/m3
USA ACGIH
ACGIH chemical category
Not Classifiable as a Human Carcinogen
USA OSHA
OSHA PEL (TWA) (mg/m3)
15 mg/m3 (total dust)
5 mg/m3 (respirable fraction)
10 mg/m3 (total dust)
5 mg/m3 (respirable dust)
USA NIOSH
NIOSH REL (TWA) (mg/m3)
Alberta
OEL TWA (mg/m3)
10 mg/m3
British Columbia
OEL TWA (mg/m3)
10 mg/m3 (total dust)
3 mg/m3 (respirable fraction)
Manitoba
OEL TWA (mg/m3)
10 mg/m3
New Brunswick
OEL TWA (mg/m3)
10 mg/m3
Newfoundland & Labrador
OEL TWA (mg/m3)
10 mg/m3
Nova Scotia
OEL TWA (mg/m3)
10 mg/m3
Nunavut
OEL STEL (mg/m3)
20 mg/m3
Nunavut
OEL TWA (mg/m3)
10 mg/m3
Northwest Territories
OEL STEL (mg/m3)
20 mg/m3
Northwest Territories
OEL TWA (mg/m3)
10 mg/m3
Ontario
OEL TWA (mg/m3)
10 mg/m3
Prince Edward Island
OEL TWA (mg/m3)
10 mg/m3
Quebec
VEMP (mg/m3)
10 mg/m3
Saskatchewan
OEL STEL (mg/m3)
20 mg/m3
Saskatchewan
OEL TWA (mg/m3)
10 mg/m3
3/6

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
Yukon OEL STEL (mg/m3)
Yukon 0 E L TWA (mg/m3)
8.2. Exposure Controls
20 mg/m3
30 mppcf
10 mg/m3
Appropriate Engineering Controls: Emergency eye wash fountain capability should be available in the immediate vicinity of any
potential exposure. Ensure adequate ventilation, especially in confined areas. Ensure all national/local regulations are observed.
Proper grounding procedures to avoid static electricity should be followed. Use explosion -proof equipment. Use local exhaust or
general dilution ventilation or other suppression methods to maintain dust levels below exposure limits. Power equipment should
be equipped with proper dust collection devices. It is recommended that all dust control equipment such as local exhaust ventilation
and material transport systems involved in handling of this product contain explosion relief vents or an explosion suppression
system or an oxygen -deficient environment.
Personal Protective Equipment: Gloves. Protective clothing. Protective goggles. Insufficient ventilation: wear respiratory protection.
, 0,000
Materials for Protective Clothing: Chemically resistant materials and fabrics.
Hand Protection: Wear protective gloves.
Eye Protection: Chemical safety goggles.
Skin and Body Protection: Wear suitable protective clothing.
Respiratory Protection: If exposure limits are exceeded or irritation is experienced, approved respiratory protection should be worn.
In case of inadequate ventilation, oxygen deficient atmosphere, or where exposure levels are not known wear approved respiratory
protection.
Other Information: When using, do not eat, drink or smoke
SECTIONPROPERTIES
9.1. Information on Basic Physical and Chemical Properties
Physical State
Solid
Appearance
Dry powder, granules
Odor
Not available
Odor Threshold
Not available
pH
Not available
Evaporation Rate
Not available
Melting Point
Not available
Freezing Point
Not available
Boiling Point
Not available
Flash Point
Not available
Auto -ignition Temperature
Not available
Decomposition Temperature
Not available
Flammability (solid, gas)
Not available
Lower Flammable Limit
Not available
Upper Flammable Limit
Not available
Vapor Pressure
Not available
Relative Vapor Density at 20°C
Not available
Relative Density
Not available
Specific Gravity
Not available
Solubility
Not available
Partition Coefficient: N-Octanol/Water
Not available
Viscosity . Not available
SECTION1
10.1. Reactivity: Hazardous reactions will not occur under normal conditions.
4/6

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
10.2. Chemical Stability: Stable under recommended handling and storage conditions (see section 7).
10.3. Possibility of Hazardous Reactions: Hazardous polymerization will not occur.
10.4. Conditions to Avoid: Direct sunlight, extremely high or low temperatures, and incompatible materials. Sparks, heat, open
flame and other sources of ignition. Dust accumulation (to minimize explosion hazard).
10.5. Incompatible Materials: Strong acids, strong bases, strong oxidizers. Sulfuric acid. Nitric acid.
10.6. Hazardous Decomposition Products: None known.
11.1. Information on Toxicological Effects - Product
Acute Toxicity (Oral): Not classified
Acute Toxicity (Dermal): Not classified
Acute Toxicity (Inhalation): Not classified
LD50 and LC50 Data: Not available
Skin Corrosion/Irritation: Not classified
Eye Damage/Irritation: Not classified
Respiratory or Skin Sensitization: Not classified
Germ Cell Mutagenicity: Not classified
Carcinogenicity: Not classified
Specific Target Organ Toxicity (Repeated Exposure): Not classified
Reproductive Toxicity: Not classified
Specific Target Organ Toxicity (Single Exposure): Not classified
Aspiration Hazard: Not classified
Symptoms/injuries After Inhalation: Dust may be harmful or cause irritation.
Symptoms/Injuries After Skin Contact: Prolonged exposure may cause skin irritation.
Symptoms/Injuries After Eye Contact: May cause slight irritation to eyes.
Symptoms/Injuries After Ingestion: Ingestion is not likely to be harmful or have adverse effects.
Chronic Symptoms: Repeated or prolonged contact with skin may cause dermatitis.
11.2. Information on Toxicological Effects - Ingredient(s)
LD50 and LC50 Data:
Sucrose (57-50-1)
LD50 Oral Rat 29700 mg/kg
12.1. Toxicity
Ecology - General: Not classified.
12.2. Persistence and Degradab
Extra Fine Granulated Sugar (57-50-1)
Persistence and Degradability
12.3. Bioaccumulative Potential
Not established.
Extra Fine Granulated Sugar (57-50-1)
Bioaccumulative Potential I Not established.
12.4. Mobility in Soil Not available
12.5. Other Adverse Effects
Other Information: Avoid release to the environment.
13.1. Waste treatment methods
Waste Disposal Recommendations: Dispose of contents/container in accordance with local, regional, provincial, territorial, national,
and international regulations
Additional Information: Container may remain hazardous when empty. Continue to observe all precautions.
Ecology - Waste Materials: Avoid release to the environment.
5/6

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
The shipping description(s) stated herein were prepared in accordance with certain assumptions at the time the SDS was authored,
and can vary based on a number of variables that may or may not have been known at the time the SDS was issued.
14.1. In Accordance with DOT Not regulated for transport
14.2. In Accordance with IMDG Not regulated for transport
14.3. In Accordance with IATA Not regulated for transport
14.4. In Accordance with TDG Not regulated for transport
15.1. US Federal Regulations
Extra Fine Granulated Su
SARA Section 311/312 Hazard Classes
Fire hazard
Sudden release of pressure hazard
Sucrose (57-50-1)
Listed on the United States TSCA (Toxic Substances Control Act) inventory
15.2. US State Regulations
Sucrose (57-50-1)
U.S. - Massachusetts - Right To Know List
U.S. - Pennsylvania - RTK (Right to Know) List
15.3. Canadian Regulations
Sucrose (57-50-1)
Listed on the Canadian DSL (Domestic Substances List)
Revision Date 12/22/2016
Other Information This document has been prepared in accordance with the SDS requirements of the OSHA
Hazard Communication Standard 29 CFR 1910.1200 and Canada's Hazardous Products
Regulations (HPR).
This information is based on our current knowledge and is intended to describe the product for the purposes of health, safety and
environmental requirements only. It should not therefore be construed as guaranteeing any specific property of the product.
NA GHS SDS 2015 (US, Can, Max)
6/6