WQ0006992_Complete File - Historical_20200929

Via Email and US Mail
January 6, 2017
NC DEQ
DWR Water Quality Regional Operation Section (WQRPS),
Groundwater Protection Branch — UIC Program Manager
1636 Mail Service Center,
Raleigh, NC 27699
Attention: Mr. Michael Rogers, PG
hart ` ''hickman
SMARTER ENVIRONMENTAL SOLUTIONS
i,tCEIVED/NCDEQ/DWr
JAN 13 2017
'Water Quality Regional
Operations Section
Re: Termination of Non -Discharge Permit #WQ0006992
Infiltration Gallery Abandonment and Monitoring Well Conversion
Oracle Flexible Packaging, Plant #604
220 E. Polo Road, Winston-Salem, North Carolina
IHSB Site #NCD067441394
H&H Project No. ORA.013
Dear Mr. Rogers:
On behalf of Oracle Flexible Packaging (Oracle), Hart & Hickman, PC (H&H) performed
infiltration gallery abandonment and recovery well modifications at Plant 604 located at 220 E.
Polo Rd. in Winston-Salem, NC (Figure 1). The conversion of eleven former recovery wells to
groundwater monitoring wells and the abandonment of the infiltration gallery and associated well
and gallery piping is a result of Oracle's decision not to renew Non -Discharge Permit
#WQ0006992 scheduled to expire on October 31, 2016. This work was performed as detailed in
H&H's proposed work plan dated October 20, 2016 followed by DEQ work plan acceptance on
November 10, 2016.
Remediation System Description
The previous groundwater remediation system consisted of eleven 4-in diameter groundwater
recovery wells (RW-2 through RW-12) each equipped with electric submersible pumps that
2923 South Tryon Street, Suite 100 ( 3334 Hillsborough Street
Charlotte, NC 28203 Raleigh, NC 27607 www.harthickman.com
704.586.0007 main 919.847.4241 main

Rogers, Michael
From: Kevin Slaughter <[e-mail]>
Sent: Friday, January 06, 2017 3:53 PM
To: Rogers, Michael
Cc: Qi, Qu; Wang, Shuying; Snow, William Scott; Matt Bramblett
Subject: Termination of Non -Discharge Permit WQ0006992 - Oracle Flexible Packaging - Plant 604
Attachments: Closure Report_20170106.pdf
Michael,
Please find the attached report for the above site in PDF format. A hard copy is also being sen to your attention
by mail. If you have any questions or comments, please let us kn�w____-__ - -
Thanks,
Kevin
J. Kevin Slaughter, Senior Environmental Scientist
Hart & Hickman, PC 12923 South Tryon Street, Suite 100 1 Charlotte, NC 28203
Direct 704-887-4615 1 Mobile [phone] Main 704-586-0007
www.harthickman.com
Id
hart h{C4(t` an
iJApJsTER E_Fd4^Rf,�s..sr ::�:.... SOiiJT1©ti

Mr. Michael Rogers, PG
January 6, 2017
Page 2
pumped groundwater to a remediation system building (Figure 2). Extracted groundwater was
then treated using three packed column air strippers plumbed in series. Following air stripping,
treated groundwater was then pumped through two activated carbon treatment vessels (also
plumbed in series) before being discharged to an on -site infiltration gallery located
approximately 1,000 ft northeast of the treatment system. In addition to the eleven submersible
pumps, nine of the eleven recovery well heads were attached to a vacuum blower using 2-in
diameter PVC piping to enhance groundwater recovery rates. Per letter notification (dated June
22, 2010) from Mr. David Yount of Oracle to Mr. Ted Bush, Section Chief, Aquifer Protection
System, the groundwater treatment system has not operated since July 2010.
Infiltration Gallery Closure
On November 29, 2016, H&H personnel collected an infiltration gallery gravel sample from
approximately 4.5 ft below land surface (bls) to characterize the gravel for disposal purposes.
The sample was collected using a hand auger (Figure 3). Gravel was encountered approximately
2.5 ft bls directly beneath both a high density polyethylene (HDPE) liner and a geotextile liner.
The gravel layer was greater than the 1-2 ft depth anticipated based on proposed gallery design
records. No as -built drawings of the infiltration gallery construction are available. When field
screened using a photo -ionization detector (PID), no vapors were detected in the gravel sample.
The sample was submitted under chain -of -custody protocol to PACE Analytical for analysis of
Toxicity Characteristic Leaching Procedure VOCs. No VOCs were detected in this sample
(Appendix A).
On December 7, 2016, H&H personnel met Sweetwater Utility Exploration, EVO Corporation
and Geologic Exploration, Inc. (GEX) on -site to begin infiltration gallery closure and recovery
well modification activities. Following utility locating and removal of power to the infiltration
gallery level control switches by GEX's electrician (including permanently removing power to
the remediation system), GEX started stockpiling gallery overburden soil above the HDPE liner
for later use. During this process, it was determined that instead of two individual trenches
running parallel to each other as originally believed based on proposed gallery design drawings
S:\AAA-Master Projects\Oracle\ORA-013 Polo Road Infiltration Gallery Closure\Closure Report\Closure Report.doc hart : h i c k m a n
SMARTER ENVIRONMENTAL SOLUTIONS

Mr. Michael Rogers, PG
January 6, 2017
Page 3
and the locations of existing piezometers, there was actually one large gallery measuring
approximately 106 ft long, 17 ft wide and 9.5 ft deep. The entire gallery including the sidewalls
were wrapped in a geotextile fabric, and the top of the gallery had an additional 10 mil HDPE
liner to prevent water and soil infiltration into the diffuser pipes. The gallery consisted of
approximately 7 ft of washed gravel, two 4 inch diameter treated water diffusion pipes and three
2-in diameter PVC piezometers extending almost to the bottom of the gallery. One of the
piezometers (southeast corner of gallery) contained water level sensors to prevent overfilling of
the infiltration gallery (Figure 3). The former piezometers and the electrical junction box were
each surrounded with a 3 ft tall yellow tube steel protective barrier which were removed.
Once overburden soil above the HDPE liner was scraped to the side and stockpiled, the gallery
contents (gravel, distribution piping, liner material, and piezometers) were excavated.
Approximately 595.7 tons of material were removed from site and trucked to EVO's facility for
treatment and disposal. Disposal documentation is provided in Appendix B. During excavation
of the gallery contents, no PID readings above background were detected and no staining was
observed. The 2-in diameter PVC treated water transfer line was cut off below grade, sealed with
hydraulic cement a minimum of 10 times the pipe's inner diameter, and a 2 inch PVC slip cap
was glued on to the former PVC transfer pipe. Following removal of the former gallery contents,
clean fill dirt was trucked in, spread and compacted within the gallery excavation area to within
approximately 1.5 ft of land surface. The remainder of the gallery excavation was filled with
compacted overburden soil. On December 12, 2016, final grading, seeding and application of
straw was performed. Photographs of the gallery abandonment work performed are contained in
Appendix C.
Recovery Well Conversion
For potential future groundwater monitoring, Oracle requested that the former recovery wells be
converted to monitoring wells. On December 7 and 8, 2016, Geologic Exploration (GEX, a NC
certified well driller) performed tasks associated with converting eleven former recovery wells
(RW-2 thru RW-12) to groundwater monitoring wells (MW-20 thru MW-30). Prior to
5:\AAA-Master Projects\Oracle\ORA-013 Polo Road Infiltration Gallery Closure\Closure Report\Closure Report.doc hart : h i c k m a n
SMARTER ENVIRONMENTAL SOLUTIONS

Mr. Michael Rogers, PG
January 6, 2017
Page 4
performing work on the remediation system, an electrician disconnected wiring and removed
breakers within the remediation system enclosure preventing the system from being restarted in
the future or the recovery wells from being energized. Each of the former recovery wells are 4-in
diameter stainless steel wells and are located inside 2 ft x 2 ft locking steel vaults. At each well
location, the submersible pump along with in -well and vault piping and electrical wiring were
removed. The former 1-in diameter PVC water discharge line, 2-in PVC vacuum line and
electrical conduit line were cut off where they entered each well vault and grouted with hydraulic
cement, in the manner discussed previously. The PVC water line and vacuum line entering each
vault were also sealed with PVC slip caps glued onto each line. New locking expansion plugs
were installed in each of the 4-in wells and locked. The steel vault lids were bolted down.
Submersible pumps, piping, and electrical wiring were removed from the site by GEX.
Eleven 1-in diameter steel insulated groundwater recovery lines (each line transitioned from PVC
to steel below grade) were cut off where they entered the remediation building, were grouted, and
capped with a 1-in diameter PVC slip cap. The 2-in diameter PVC vacuum assist/extraction
lines were disconnected from the blower system, cut off at land surface, grouted, and a 2-in PVC
slip cap was glued onto the piping. On the system discharge piping to the infiltration gallery,
approximately 5 ft of foam insulated steel piping was cut off at the remediation building below
grade and grouted. Because of the composition of the pipe, GEX was unable to press fit a cap
onto the steel pipe. Therefore, additional grout was used to seal the discharge line (> 10 pipe
diameters) and excess grout was used to fill the excavation flush with land surface.
On January 5, 2017, GEX returned to the site and permanently affixed new well tags to the
interior of each monitoring well vault. Well construction information including former and
current labeling are contained in Table 1. Photographs of the well conversion and line
abandonment activities are contained in Appendix C.
S:\AAA-Master Projects\Oracle\ORA-013 Polo Road Infiltration Gallery Closure\Closure Report\Closure Report.doc
hart hickman
SMARTER ENVIRONMENTAL SOLUTIONS

Mr. Michael Rogers, PG
January 6, 2017
Page 5
By submitting this closure report documenting gallery closure and well conversion activities,
H&H believes Oracle has fulfilled its obligations to NC DEQ for termination of its Non -
Discharge Permit #WQ0006992. We look forward to your review and approval of this closure
report. Should you have any questions or need additional information, please do not hesitate to
contact us at [phone].
Very truly yours,
Hart & Hickman, PC
J. Kevin Slaughter
Senior Environmental Scientist
Attachments
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SEAL
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Matt Bramblett, PE -ell V. � ;'
Principal
Cc: Mr. Scott Snow, P.E. - Oracle (PDF by Email and Hard Copy by Mail)
Mr. Qu Qi, P.G. - NCDEQ (PDF by Email)
Ms. Shuying Wang, P.G. - NCDEQ (PDF by Email)
S-\AAA-Master Projects\Oracle\ORA-013 Polo Road Infiltration Gallery Closure\Closure Report\closure report.doc
hart hickman
SMARTER ENVIRONn 1L SOLUTIONS

Table 1
Monitoring Well (Former Recovery Well) Construction Table
Oracle Plant 604
Winston-Salem, North Carolina
H&H Job No. ORA- 013
Monitoring
Well
Designation
Former
Recovery
Well
Designation
Installation
Date
Well
Diameter
(in)
Well
Depth
(ft)
Well
Casing and
Screen
Material
Screen
Interval
(ft)
MW-20
RW-2
4/1992
4
54.0
Stainless Steel
not available
MW-21
RW-3
4/1992
4
54.0
Stainless Steel
not available
MW-22
RW-4
4/1992
4
56.0
Stainless Steel
not available
MW-23
RW-5
4/1992
4
34.5
Stainless Steel
not available
MW-24
RW-6
8/1995
4
39.0
Stainless Steel
not available
MW-25
RW-7
8/1995
4
34.5
Stainless Steel
7.0 - 34.5
MW-26
RW-8
8/1995
4
29.5
Stainless Steel
7.5 - 29.5
MW-27
RW-9
8/1995
4
34.5
Stainless Steel
7.5 - 34.5
MW-28
RW-10
8/1995
4
34.5
Stainless Steel
7.5 - 34.5
MW-29
RW-11
8/1995
4
34.5
Stainless Steel
7.5 - 34.5
MW-30
RW-12
8/1995
4
34.5
Stainless Steel
7.5 - 34.5
Notes:
"not available" - screen interval currently unknown.
CEI'✓EDi"!CDEQlDM,
,.N13201i
Region,
Section
Fib. S. WJ-Masbr Propctsl0racb10RA-013 Pdo RoaE Infiltra4on Galbry Obsure\Cbwre ReporllWetl Cmversian T.N. SVE System O&M Table 1 (Page 1 of 1)
Date: 116/2017 Hurt & Hickman, PC

4" PVC SLIP CAPS AT END OF 4"
PVC DISTRIBUTION LINES
9.5'
OUTER EDGE OF
INFILTRATION GALLERY
GEOTEXTILE LINED/ GRAVEL
FILLED INFILTRATION GALLERY
1 T 6'
(2) 100', 4" DIA. PVC DISTRIBUTION PIPING WITH 2
ROWS OF 3/4" HOLES DRILLED IN TOP OF PIPING
ELECTRICAL—'.—
JUNCTIONBOXONLY _--------_ �— -
- — TRANSFER LINE
2" DIA PVC WATER
3/4" PVC
ELECTRICAL CHASE
C,
INFILTRATION GALLERY -
PLAN VIEW APPROXIMATE
2" SLOTTED PVC PIEZOMETER
(1 OF 3)
2.5' COMPACTED
SOIL
T GRAVEL
10 MIL. HDPE LINER
(TOP OF TRENCH ONLY)
GEOTEXTILE FABRIC
(LINES ENTIRE TRENCH)
4" PVC DISTRIBUTION
LINE (1 OF 2)
X . . . . . . . . . /
N
SOIL
PROTECTIVE STEEL
BARRIER (TYP.)
ELECTRICAL JUNCTION
BOX (TYP.)
3/4" PVC ELECTRICAL
CONDUIT
PVC TRANSFER LINE
LEGEND
6' CHAINLINK FENCE
—
2" DIA. PVC WATER TRANSFER
LINE
3/4" PVC ELECTRICAL CHASE
(LIQUID LEVEL SENSOR LINE)
>
PROTECTIVE STEEL BARRIER
2" DIA PIEZOMETER
O
SOIL BORING TAKEN PRIOR TO
GALLERY REMOVAL
•
ELECTRICAL JUNCTION BOX
APPROXIMATE
0 15 30
moommommomi
SCALE IN FEET
PROFILE VIEW

Appendix A
Gravel Laboratory Analytical Results
Hart & Hickman, PC

aceAnalytical
wwwpacefabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
December 01, 2016
Kevin Slaughter
Hart & Hickman
2923 South Tyron St
Charlotte, NC 28203
RE: Project: ORA-013
Pace Project No.: 92321128
Dear Kevin Slaughter:
Enclosed are the analytical results for sample(s) received by the laboratory on November 29, 2016.
The results relate only to the samples included in this report. Results reported herein conform to the
most current, applicable TNI/NELAC standards and the laboratory's Quality Assurance Manual,
where applicable, unless otherwise noted in the body of the report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Kevin Godwin
[e-mail]
Project Manager
Enclosures
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
Page 1 of 11

ceAnalytical
Wmpsoakbs.00m
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
Project: ORA-013
Pace Project No.: 92321128
Charlotte Certification IDs
9800 Kincey Ave. Ste 100, Huntersville, NC 28078
North Carolina Drinking Water Certification #: 37706
North Carolina Field Services Certification #: 5342
North Carolina Wastewater Certification #: 12
CERTIFICATIONS
South Carolina Certification #: 99006001
Florida/NELAP Certification #: E87627
Kentucky UST Certification #: 84
Vrginia/VELAP Certification #: 460221
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC.
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aceAnalyticaI
www.pacelabs.oan
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE SUMMARY
Project: ORA-013
Pace Project No.: 92321128
Lab ID Sample ID Matrix Date Collected Date Received
92321128001 GALLERY Solid 11/29/16 08:25 11/29/16 15:00
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC.
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"07
10,4 ace Analytical"
www.pacelabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
SAMPLE ANALYTE COUNT
Project: ORA-013
Pace Project No.: 92321128
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92321128001 GALLERY EPA 8260 DLK 14 PASI-C
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, LLC. Page 4 of 11

1�;a'ceAnalyficale
..pacelabs.am
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
ANALYTICAL RESULTS
Project: ORA-013
Pace Project No.: 92321128
Sample: GALLERY Lab ID: 92321128001 Collected: 11/29/16 08:25 Received: 11/29/16 15:00 Matrix: Solid
Results reported on a "wet -weight" basis
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
8260 MSV TCLP
Benzene
2-Butanone (MEK)
Carbon tetrachloride
Chlorobenzene
Chloroform
1,4-Dichlorobenzene
1,2-Dichloroethane
1,1-Dichloroethene
Tetrachloroethene
Trichloroethene
Vinyl chloride
Surrogates
1,2-Dichloroethane-d4 (S)
Toluene-d8 (S)
4-Bromofluorobenzene (S)
Date: 12/01/2016 03:24 PM
Analytical Method: EPA 8260 Leachate Method/Date: EPA 1311; 11/30/16 10:15
ND
ug/L
192
38.5
11/30/16 21:35
71-43-2
ND
ug/L
385
38.5
11/30/16 21:35
78-93-3
ND
ug/L
192
38.5
11/30/16 21:35
56-23-5
ND
ug/L
192
38.5
11/30/16 21:35
108-90-7
ND
ug/L
192
38.5
11/30/16 21:35
67-66-3
ND
ug/L
192
38.5
11/30/16 21:35
106-46-7
ND
ug/L
192
38.5
11/30/16 21:35
107-06-2
ND
ug/L
192
38.5
11/30/16 21:35
75-35-4
ND
ug/L
192
38.5
11/30/16 21:35
127-18-4
ND
ug/L
192
38.5
11/30/16 21:35
79-01-6
ND
ug/L
192
38.5
11/30/16 21:35
75-01-4
109
%
70-130
38.5
11/30/16 21:35
17060-07-0 1g
101
%
67-135
38.5
11/30/16 21:35
2037-26-5
95
%
70-130
38.5
11/30/16 21:35
460-00-4
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services, LLC.
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aceAnalytical
wawpacwos.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA
Project: ORA-013
Pace Project No.: 92321128
QC Batch: 338744 Analysis Method: EPA 8260
QC Batch Method: EPA 8260 Analysis Description: 8260 MSV TCLP
Associated Lab Samples: 92321128001
METHOD BLANK: 1878211
Associated Lab Samples: 92321128001
Parameter
Units
Matrix:
Blank
Result
Water
Reporting
Limit
Analyzed
1,1-Dichloroethene
ug/L
ND
5.0
11/30/16 11:43
1,2-Dichloroethane
ug/L
ND
5.0
11/30/16 11:43
1,4-Dichlorobenzene
ug/L
ND
5.0
11/3011611:43
2-Butanone (MEK)
ug/L
ND
10.0
11/30/16 11:43
Benzene
ug/L
ND
5.0
11/30/16 11:43
Carbon tetrachloride
ug/L
ND
5.0
11/30/16 11:43
Chlorobenzene
ug/L
ND
5.0
11/30/16 11:43
Chloroform
ug/L
ND
5.0
11/30/16 11:43
Tetrachloroethene
ug/L
ND
5.0
11/30/16 11:43
Trichloroethene
ug/L
ND
5.0
11/30/16 11:43
Vinyl chloride
ug/L
ND
5.0
11/30/16 11:43
1,2-Dichloroethane-d4 (S)
%
113
70-130
11/30/16 11:43
4-Bromofluorobenzene (S)
%
95
70-130
11/30/16 11:43
Toluene-d8 (S)
%
101
67-135
11/30/16 11:43
Qualifiers
LABORATORY CONTROL SAMPLE:
Parameter
1878212
Units
Spike
Conc.
LCS
Result
LCS
% Rec
% Rec
Limits
1,1-Dichloroethene
ug/L
50
53.3
107
66-135
1,2-Dichloroethane
ug/L
50
54.5
109
67-128
1,4-Dichlorobenzene
ug/L
50
49.5
99
78-130
2-Butanone (MEK)
ug/L
100
105
105
61-144
Benzene
ug/L
50
53.0
106
80-125
Carbon tetrachloride
ug/L
50
51.0
102
69-131
Chlorobenzene
ug/L
50
50.9
102
81-122
Chloroform
ug/L
50
51.6
103
73-127
Tetrachloroethene
ug/L
50
44.9
90
78-122
Trichloroethene
ug/L
50
53.4
107
78-122
Vinyl chloride
ug/L
50
48.2
96
58-137
1,2-Dichloroethane-d4 (S)
%
108
70-130
4-Bromofluorobenzene (S)
%
103
70-130
Toluene-d8 (S)
%
101
67-135
Qualifiers
Results presented on this page are in the units Indicated by the "Units" column except where an aitemate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
Date: 12/01/2016 03:24 PM without the written consent of Pace Analytical Services, LLC.
Page 6 of 11

aceAnalytical
www.pacekbs.mm
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALIFIERS
Project: ORA-013
Pace Project No.: 92321128
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to dilution of the sample aliquot.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL -Adjusted Method Detection Limit.
PQL - Practical Quantitation Limit.
RL - Reporting Limit.
S - Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270. The result for each analyte is
a combined concentration.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
SG - Silica Gel - Clean -Up
U - Indicates the compound was analyzed for, but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited. Contact your Pace PM for the current list of accredited analytes.
TN - The NELAC Institute.
LABORATORIES
PASI-C Pace Analytical Services - Charlotte
ANALYTE QUALIFIERS
1 g 8260 results are from a total analysis which show that analytes are not present or that they are present but at such low
levels that the appropriate regulatory levels could not possibly be exceeded, per Section 1.2 of Method 1311.
REPORT OF LABORATORY ANALYSIS
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Date: 12/01/2016 03:24 PM without the written consent of Pace Analytical Services, LLC. Page 7 of 11

1�;a'aeAnalyficale
www.pacefabs.com
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
Huntersville, NC 28078
[phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: ORA-013
Pace Project No.: 92321128
Lab ID Sample ID QC Batch Method
92321128001 GALLERY EPA 8260
QC Batch Analytical Method
338744
REPORT OF LABORATORY ANALYSIS
Analytical
Batch
This report shall not be reproduced, except in full,
Date: 12/01/2016 03:24 PM without the written consent of Pace Analytical Services, LLC. Page 8 of 11

e
dCBAI]c7�ytlCa�
Document Name:
Sample Condition Upon Receipt(SCUR)
Document Revised: Sept. 21, 2016
Page 1 of 2
Document No.:
F-CAR-CS-033-Rev.01
Issuing Authority:
Pace Quality Office
Laboratory receiving samples:
Asheville ❑ Eden❑ Greenwood ❑ Huntersville ❑ Raleigh❑ Mechanicsville❑
ConditionSample • • Client Name: 140# : 92321123
Receipt Project #:
Courier: []Fed Ex []UPS []LISPS []Client
❑ Commercial ❑Pace ❑Other: 512321 128
Custody Seal Present? ❑Yes ❑No Seals intact? ❑Yes ❑No
Date/Initials Person Examining Contents:
Packing Material: ❑Bubble Wrap ❑Bubble Bags ❑None ❑Other:
Thermometer:
❑1R Gun ID: 7riUL6_ Type of Ice: ❑10ret ❑Blue ❑None ❑Samples on ice, cooling Zc
cess has begun
Correction Factor: Cooler Temp Corrected (°C): ?. Biological Tissue Frozen? ❑Yes ❑N/A
Temp should be above freezing to 6°C
USDA Regulated Soil (❑ N/A, water sample)
Did samples originate in a quarantine zone within the United States: CA, NY, or SC (check maps)? Did samples originate from a foreign source (interotionally,
❑Yes ONO including Hawaii and Puerto Rico)? ❑Yes MI No
Comments/Discrepancy:
Chain of Custody Present?
Yes
[]NO
(—]N/A
1.
Samples Arrived within Hold Time?
❑ es
❑N
❑N/A
2.
Short Hold Time Analysis (<72 hr.)?
[]Yes
❑N/A
3.
Rush Turn Around Time Requested?
❑Yes
EJ4
❑N/A
4.
Sufficient Volume?
04S
[:IN.
❑N/A
S.
Correct Containers Used?
-Pace Containers Used?
( es
es
❑No
[I No
❑N/A
❑N/A
6.
Containers Intact?
EPes
[:)NO
❑N/A
7.
Samples Field Filtered?
❑Yes
/a
8. Note if sediment is visible in the dissolved container
Sample Labels Match COC?
-includes Date/Time/ID/Analysis Matrix:
Headspace in VOA Vials (>5-6mm)?
0 es
❑Yes
.[—]No
❑No
[:]No
❑N/A
' N A
9.
10.
Trip Blank Present?
Trip Blank Custody Seals Present?
[]Yes
❑Yes
[]No
❑No
/A
[�N/A
11.
CLIENT NOTIFICATION/RESOLUTION
Person Contacted:
Comments/Sample
Discrepancy:
Date/Time:
Field Data Required? []Yes [—]No
Project Manager SCURF Review: Date:
Project Manager SRF Review: Date: !i 3C
Note: Whenever there is a discrepancy affecting North Carolina compliance samples, a copy of this form will be sent to the North Carolina DEHNR Certification Office (i.e.
Out of hold, incorrect preservative, out of temp, incorrect containers)
Page 9 of 11

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6-' CHAIN -OF -CUSTODY / Analytical Request Document
Paceluu.mjcal
The Chain -of -Custody is a LEGAL DOCUMENT. All relevant fields must be completed accurately.
Section A Section 8 Section C
r
Required Client Information: Required Project Information: Invoice Information: Pa e : 1 Of 1
CompanyHan 8 Hickman Report To Kevin Slaughter Al:ention
Address 2923 South Tyron St Copy To Company Name'
Charlotte, NC 28203
Address.
Regulefory Agency
Email. kslaughter harthickman com
Purchase Order If
Pace Quote.
Phone. [phone] Fax
Project Name. ORA-013
Pace Project Manager. kevm.godwtn acelabs com.
State I Location
Requested Due Date
Project N. -. 0 17
Pace Profile 7505.4
NC
Requested
Analysis
F1
IN
2
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0
COLLECTED
Z
Preservatives
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SAMPLE ID
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END
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One Character per box. Wipe WP
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wa
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0
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Sample Ids must b0 uniqueTwee TS
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DATE
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=
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081
2
1
3
4
S
6
7
8
9
10
11
12
ADDITIONAL COMMENTS
RELINClU SHED BY I AFFILIATION
DATE
TIME
ACCEPTED BY I AFFILIATION
DATE
TIME
SAMPLE CONDITIONS
SAMPLER NAME AND SIGkATURE
$
PRINT Name of SAMPLER:
W
w }
m $ Z
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SIGNATURE -of SAMPLER•/
DATE Signed: //
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Appendix B
Gravel Disposal Documentation
Hart & Hickman, PC

Evo Corporation
1703 Vargrave Street, Winston-Salem, NC
Phone: [phone] Fax: [phone]
46, ,�®
CORPORATION
Waste Profile
Note: Information given below will be used in order to create all shipping paperwork, certificates and invoices. Please be sure wording is exactly how it needs
to read on all forms before sending in for onnrnval
Section 1: Generator Information
Generator Name: Oracle Flexible Packaging / LLFlex
Project Address: 220 E. Polo Rd. Winston-Salem, NC. 27105
_ Invoicing Company: Hart & Hickman
Generator Contact: Mr. W. Scott Snow, PE Invoicing Address: 2923 S. Tryon Suite 100
Generator Phone: [phone] Charlotte, NC 28203
Technical Contact: J. Kevin Slaughter Invoicing Contact: Kevin Slaughter
Technical Title: Senior Environmental Scientist Invoicing Phone: [phone]
ITechnical Phone: [phone] Invoicing E-Mail: [e-mail]
Technical Email: [e-mail] Invoicing Fax:
Section 2: Waste Characteristics
' Physical state at 70° F: Liquid Semisolid Solid X
Layers: None X Two Multi Viscosity: Low Medium High
' Free Liquids (%): 0 Total Solids (%): 100 Describe Gravel and trace soil
Is Material Pumpable? No Is Material Dusty?
Appearance: Gravel with trace soil Odor: None
Process generating waste: Former groundwater infiltration gallery material
Section 3: Chemical Composition Must total 100%
gravel / soil >99.9 %
%
I VOC's <0.1 %
%
Please attach all MSDS's, sample analysis and additional information.
IThe constituent information is based on _ _ Analysis (please attach) _ _ Generator Knowledge _X_ Both
Is this a non -hazardous liquid industrial waste Yes
X No
this waste contain PCB's > 50ppm Yes
X No
IDoes
Please indicate if this waste stream carries an EPA RCRA characteristic hazardous waste code (D001-D043):
D001 Does this waste exhibit the characteristic of ignitability? Yes
X No
What is the flash point of this waste? <90°F 90-140°F >140'F X >2001F
Exact
Is the waste an oxidizer? Yes
X No
D002 Does this waste exhibit the characteristic of corrosivity? Yes
X No
What is the pH of this waste? <2 2-4.9 X 5-10 10.1-12.4
I
>_12.5
D003 Does this waste exhibit the characteristic of reactivity? Yes
X No
Does this waste contain reactive cyanide >_ 250ppm OR reactive sulfide >_ 500ppm? Yes
X No
ISection 4: Shipping Information Packaging: Check all that apply
Rate of Generation One Time Bulk Soil
DOT Shipping Name Non Hazardous / Non Regulated Waste Bulk Solid X
Container Type/Size Dump Truck Bulk Liquid
Drum Soil
Drum Liquid
Other
Waste Notification and Certification:
I certify that all information on this waste profile is complete and is an accurate representation of the known contaminates pertaining to the waste
described herein. Furthermore, I certify that I am familiar with the waste as described on this form through analysis and testing or through knowledge
of
the waste generating process to support this notification that the waste is not regulated as a characteristic or listed hazardous waste under 40 CFR 261.20 or
261.30 and that the waste is not restricted as specified in 40 CFR 268, Subpart D.
(Signature: Date: 2-
Print Name: Title:

CORPORATION
1703 Vargrave street
Winston-Salem, NC 27107
ph 336-725-5844
fax [phone]
CERTIFICATE OF DISPOSAL
Evo Corporation does hereby certify that 595.65 tons of non -hazardous
contaminated material received on 12/7/2016, 12/8/2016 and 12/9/2016 from:
Generator: Oracle Flexible Packaging/LLFlex
Originating at: 220 E. Polo Rd.
Winston-Salem, NC
EC Waste ID #: 121613
has been disposed of by Evo Corporation in a manner approved by the North
Carolina Department of Environmental Quality.
Thomas W. Hammett
CEO
Evo Corporation
www.evocorp.netTHE NEXT LEVEL.

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77923
b� 'GENERATOR INFORMATIONSol~
11W N
Oracle Flexible ac agi LLF1ex - -
Generator: Phone:
Site Address:
City/State: Winston - ern, NC 2TIM Contact: Mr' W. Scott Snow, PE
Gross Weight (lbs): a0 Material: Soil
Empty Weight (lbs): a Contaminant: Non Haz VOC's
Net Weight (lbs): �5 3 a, 0
Quantity �a6 Tons Drums Pails Sacs Yards Other:
�� �TRANSPQRTERINFORMA"fION�
Transporter: Evo Corporation Phone: [phone]W
Truck #: (Q �- Contact: Tony Diaper
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable reg+}atigns governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Signature:
EVO CORPORATION
Date:
Eva Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
FacilitySignature: A 1,41-194Ix, a— ,-
9 sku :1:� Date:
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Lvo Corporation, 200E

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
... # Manifest No. 77924
Oracle FlexiblePackaging/ • •
Generator.
ZZU r�a.er roto Koan
Site Address:
City/State: Winton -Salem, NC 27105
Phone:
Contact: Mr. W. Scott snow, PE
IN-NoWw"Momw0.TERwIAL DESCRIPTIONQUANTI1l'N/1NE1GH
Gross Weight (lbs):
is- S Q ;;? 0 Material:
Empty Weight (Ibs): c� oZ G 5 U
Net Weight (Ibs): b75-3 qC)
Quantity 1 7' 49,
Transporter: Eva Corporation
Truck #: t o ;L
-
Contaminant:
Ron Ha z VOC'e
TG� Drums Pails Sacs Yards Other:
Phone: [phone]
Contact: Tony Fisher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations gove Ing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Siqnature:
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Date: / a ~ 1 - % 6
Evo Project* 121613
Phone: [phone]
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator:
Site Address:
City/State: WinstUneni.
INC 21105
Manifest No. 77925
Phone:
Contact: Mr. W. Scott Snow, PE
/
Gross Weight (lbs): Z- (i 0 Material: Sad
EmptyWeight (lbs): Nan Haz VQC's
9 ( ) 2Z � � � Contaminant:
Net Weight (lbs): 3 EO
Quantity 69 on Drums Pails Sacs Yards Other:
Transporter:
Evo Corporation
Truck #: 1 fl -
Phone: [phone]
Contact: Tony Diener
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations goveming transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #:
EVO CORPORATION
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facility Signature: 4�f+VA? aZLi Date:
White/Facility Canary/invoice Goldenrod/Generator Pink/Carrier
Evo Corporntion, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77890
Oracle Flexible Packaging/ LLFIex 336-777-5878
Generator: Phone:
220 East o 0 Road
Site Address:
City/State:
Winston-Salem, NC 27105 Contact: Mr. W. scoff snow, PE
Gross Weight (lbs): 77 T o<y
Empty Weight (Ibs): o22_90
Net Weight (lbs): d,42 0(40
Quantity 1 `, oa
Material:
Contaminant:
Non Haz VOC's
Te Drums Palls Sacs Yards Other:
Transporter: Evo Corporation Phone: [phone]
Truck M Ian Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Signature:
EVO CORPORATION
Date:
Evo Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facilitv Sianature: � \ b Date: I —1 4
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No
Oracle Flexible Packaging/ LLFile=
Generator: Phone:
220 East o Road
Site Address:
City/State: Mn®ton-Salem, NC 27105 Contact:
Gross Weight (lbs): q�20
Empty Weight (Ibs): 7� d- � B 0
Net Weight (Ibs): Oqb
Quantity l i 14 a
Material:
77896
777-5878
Mr. W. Scatt Snow, PE
Contaminant: Non Haz VCC's
U Drums Pails Sacs Yards Other:
Transporter: Evo Corporation Phone: [phone]W
Truck #: I Q a Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regula6o(r"ming transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Signature:
EVO CORPORATION
Date:
Evo Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facilltv Signature: Date: f L—_? —
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 EM Polo Road
Site Address:
City/State: imftn em, NCC 27105
Gross Weight (lbs): o U
Empty Weight (lbs): (, _
Net Weight (lbs): g B3 4 O
Quantity I It e
Material:
Manifest No
Phone:
77897
Contact: Mr' W. Scott Snow, PE
Soil
Non Haz VOC'®
Contaminant:
Cqn Drums Pails Sacs Yards Other:
Transporter: Evo Corporation Phone: [phone]
Truck #: 1 Contact: Tony Maher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver-
�..�`�,.--'sue`
ProjectEvo
121613
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Phone: [phone]
Contact: Tonv Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facilit Si nature:qz_144f Date: / `�
_��
€OWN
�`tH�":p�- ""'-^_) "`,.x�. A
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77900
LLF1ea
Generator:
zzu raez rolo iKoaa
Site Address:
City/State: eton-Salem, NC 27145
Gross Weight (lbs): ]A Material:
Empty Weight (lbs): Contaminant:
Net Weight (lbs):
Quantity 22 , 5 To sl
Transporter: Evo Co ration
11
Truck #: tP I
Phone:
Contact: Mr' W. Scott Snow, PE
Soil.
Ron Haz VOC's
Drums Pails Sacs Yards Other:
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce nder the applicable regulations gn
ming transportation, and I hereby receive this material for
delivery to the fa ' 't designate. n
Driver Sicma 1 �L'"---1y Date: i Z / 06
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Signature: �g18�Lu C Jum Date: j_�' 6_~
White/Facility Canary/Invoice Goldenrod/Generator Pink/Canier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 East Polo Road
Site Address:
City/State: Winstop em,
NC 27105
Manifest No. 7 7 9 01
Phone:
Contact:
Mr. W. Seott Snow, PE
Gross Weight (lbs): l 1 7(� d Material: o
il
Empty Weight(lbs): Contaminant: Non Haz VOC's
Net Weight (lbs):
Quantity Z3 Z� Ton Drums Pails Sacs Yards Other:
Transporter: Evo Corpo n Phone: [phone]
Truck #: Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest ar properly classified, packaged, labeled, secured and are in proper condition for transport
In commerce under a applicable regulations govemin Tnsportabon, and I hereby receive this material for
delivery to the facility de nate. / 1
Driver Sianature: fN i -a r ,_ k1A / u'lDate: 17/0)/4 110
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carder has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facilitv Signature: Yzv� �&w Date:
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carder
Evo corporodon, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 East Polo Road
Site Address:
City/State: instofl em,
NC 27105
Manifest No.
Phone:
77917
Contact:
Mr. W. Scott Snow, PE
Gross Weight (lbs): �Z_o 2_��O Material: soil
Empty Weight (Ibs):
333Contaminant: LA v Non Haz VOC'®
�
Net Weight (Ibs): —t6y
Quantity 71,E c 5? ons Drums Pails Sacs Yards Other:
G. !
Transporter: Evo Coyrration
Truck #:
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials marQest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce un the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility esignate.
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Eva Project #:
121613
Phone: [phone]
Contact: Tony Disher
certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Fac ity Si nature Date:
0 INS�n�
.>.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVOZORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocarp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77918
Oracle Flexible Packaging/ LLFlea
Generator:
zzu zaw roto coact
Site Address:
City/State: Winston-Salem, NC 2?105
336-777-5878
Phone:
Contact: Mr. W. Scott Snow, PE
Gross Weight (lbs): � Material: 30
Empty Weight (Ibs): V 3'Ag Contaminant: Non Iiaz VOC'®
Net Weight (Ibs): 1 (0 V&O
Quantity Z6. q8 Tons Drums Pails Sacs Yards Other:
Transporter:
Evo Corporation
Truck #:
IV
Phone: [phone]
Contact: Tony Di®her
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are property classified, packaged, labeled, secured and are in proper condition for transport
in commerce under th applicable regulations governing transportation, and 1 hereby receive this material for
delivery to the facility d�gnate. n —
Driver Siqnature:
EVO CORPORATION
ate:
Eva Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and 1 hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facility Sianature: dva,11An lX I►_ Date: a - � /V
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No.
Oracle Flexible Faciicigii W LLFlea
Generator:
ZZU Zap rolo xoaa
Site Address:
City/State: Weston -Salem, RC 27105
Gross Weight (Ibs):
Q YC3,
Material:
Empty Weight (lbs):
VS'Q
Contaminant:
Net Weight (Ibs):
5Cac
Quantity
2
1
ons Drums
11. c
Transporter: Evo Corporation
Truck
Phone:
77902
-5878
Contact: Mr' W. Scott Snow, PE
Ron Haz VOC's
Pails Sacs Yards Other:
Phone: [phone]-
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
In commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Siqnature: !A w L
EVO CORPORATION
Date: /,Z7-
Evo Project #: 121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Siqnature: ( '.AMV, ru& Date: 1,. — /—
White/Facility Canary/Invoice Goldenrod/Generator Pink/CaMer
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator:
Site Address:
City/State: WinBtonem,
Gross Weight (lbs): o �`7 Material:
Empty Weight (lbs): 3J r/7 L-, Contaminant:
Net Weight (Ibs):
Quantity / c�0 (Zos Drums
Transporter: Evo Corporation
Truck #:
Manifest No. 77903
Phone:
Contact: Mr. W. Scott Snow, PE
Soil
Non Haz VOC's
Pails Sacs Yards Other:
Phone: [phone]
Contact: Tang Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
In commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #
EVO CORPORATION
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo corpom ion, 2009

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No
Oracle Flexible Packaging/ LLFlex
Generator:
tzu za y- rota rcoaa
Site Address:
City/State: Winston-Salem, NC 27105
Gross Weight (lbs): 718� 110
Empty Weight (lbs): N�o
Net Weight (lbs): `-1 `_-d -6CD
Quantity '22 ! rq
Transporter: Evo Corporation
Truck #: i
Material:
[wit
77904
Contact: Mr. W. Scott Snow, PE
Soil
Contaminant:
Ron Haz VOC's
Tons Drums Pails Sacs Yards Other:
Phone: [phone]
Contact: Tony Diaher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony_ Disher
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 East Polo Road
Site Address:
City/State: mston- em, Me 171-05
Manifest No. 7 7 8 9 9
Phone:
Contact: Mr' W. soft Snow, PE
���� A ERA DESC 11��0 �Q[JA I
Gross Weight (Ibs): 75 %?y Material:o�
Empty Weight (Ibs): 31 _1q Non Haz VOC's
Contaminant:
Net Weight (lbs):
Quantity �JQ p! Tons Drums Pails Sacs Yards Other:
_� ��I:tANSPO`� Ei1NFCi.�2M�A�TION� �
Transporter: Evo Corporates
Truck #:
Phone: [phone]
Contact: finny Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Sienature:
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
� 1/'/1'P1__1' Date:
Evo Project #
121613
Phone: [phone]
Contact: Tonv Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facility Signature: Date:
M.
-1�
L N
White/Facility Canary/Invoice Goldenrod/Generator �Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No.
LLF1e=
Generator:
zzu Ciasi rala jKoaa.Q
Site Address:
City/State: Winston-Salem, RC 27105
Phone:
77893
Contact: Mr' W. Scott Snow, PE
Gross Weight (lbs): Z 7 (�, o Material: soil
Empty Weight (lbs): � -0 Contaminant: Non Haz �TOC'e
Net Weight (lbs): = ��09 0
Quantity % �, 0 Z (Tons Drums Pails Sacs Yards Other:
Transporter: Evo C rporati+on
Truck #:
Phone: [phone]
Contact: Tony Di.Bher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce the applicable regulations governing ar portation, and I hereby receive this material for
deliveryto the facility ignate.
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carder has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Sionature:
White/Facility
Evo Corporation, 2008 r
Date.
Canary/Invoice Goldenrod/Generator
Pink/Carrier

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No.
Oracle Flexible Packaging/ LLFlex
Generator:
Site Address: c;cv naim row moan
City/State: Wimton-Salem, NC 27105
336-
Phone:
77894
Contact: Mr. W. Scott Snow, PE
Gross Weight (Ibs): Z q6O Material: Soil
EmptyWeight Ibs : Hofl Haz VOC'e
9 ( } Contaminant:
Net Weight (Ibs): -1
Quantity Q� �7L Don Drums Pails Sacs Yards Other:
Transporter: Evo Co ration
Truck #:
Phone: [phone]
Contact: Tony Di.®her
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials mapirfest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce un a applicable regulations goveyaig transportation, and I hereby receive this material for
delivery to the facility designate. JJ.1 / },.�
Driver Si
Date: ? Z/ 0
Evo Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carder has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo CorpmaUon, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77892
Oracle Flexible Packaging/ LLFlex 336-777-5878
Generator: Phone:
220 Fast o 0 Road
Site Address:
City/State: Wint(n-Salem, NC 27105 Contact: Mr. W. Scott Snow, PE
Gross Weight (Ibs):
8)+ 404 0
Material:
soil
EmptyWeight Ibs :
9 ( )
3� �, d Q
Contaminant:
Ron Ha.z VOCIa
Net Weight (Ibs):
Quantity
�,
Tons Drums
Pails Sacs Yards Other:
Transporter:
Fvo Corporation
Phone: [phone]
Truck #:
aZ% to
Contact: Tony Disaher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are property classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and 1 hereby receive this material for
delivery to the facility designate.
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Evo Project #: 121613
Phone: [phone]
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
Facility Signature: 6X-e7A Date: /./,� -- _-'), (-
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
[vo Corpomdon, 2008
.:A

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 Baim BOW Road
Site Address:
City/State: Winston-Salem, WC 27 005
Gross Weight (lbs): &4 080
Empty Weight (lbs): 3 a a CSC)
Net Weight (Ibs)
Quantity
Transporter:
Manifest No. 77891
Phone:
Contact: Mr. W. Scott Snow, PE
Material:
;Soil
Contaminant:
Non Haz VOCI%
Tons Drums Pails Sacs Yards Other:
Phone: [phone]W
Truck #: 1� ) �a Contact: Tony DiQher
Evo Corporation
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility desjgpate.
Eva Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carder
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net `
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77907
x��c ,?,.. ', `-''..`\��."�.``."�..
GENERATOR INFORMATION 31 . > f
Oracle Flexible Paokagine LLF ox ^7^ 336-777-5878
Generator: Phone:
220 hast rolo Road
Site Address:
City/State:
Winston-Salem, NC 27105 Contact: Mr. W. Seott Snow, PE
Gross Weight (lbs): 9'� o�
Empty Weight (lbs): AQO
Net Weight (lbs):
Quantity
Transporter:
Material:
Contaminant:
�y
A 0
�. '36 Tons
Eva Corporation
Soff
Non Haz VOC'&
Drums Pails Sacs Yards Other:
Phone: [phone]
Truck #: 6 . / 6 Contact: Tony Deer
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
" V V 1 I VJ V V% TT.
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Signature: " Date: I --
Mil
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Eco Carpurwion, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77908
Oracle Fleidble Packaging) LLFIea 336-777-5878
Generator: Phone:
220 Fast o a Road
Site Address:
City/State: Winston-Salem, RC 27105 Contact: Mr. W. Scott Snow, PE
m, - ��, �,�MATERI/�L;DESCRIPTIQN�QU4NT'I _�, �/�1IVEiGHT�.�x�
Gross Weight (lbs): ' S Z 8 D Material: Soilt
Empty Weight (lbs): 3 J n 0 Contaminant: Non Haz VOC's
Net Weight (lbs): 4 J 9 8 D
Quantity , g9 Tons Drums Pails Sacs Yards Other:
Transporter: Evo Corporation Phone: [phone]
Truck #: aZ / 6 Contact: Tony Fisher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
In commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Evo Project #:
121613
Phone: [phone]
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Signature: 4,�('wkwin CALv, Date:
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corpm ion, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 East Boto Road
Site Address:
City/State: imton em, NC 271-0
Gross Weight (lbs):
Empty Weight (Ibs):QQ
Net Weight (Ibs)
Quantity
Transporter:
.� o 10
0 lc�
Material:
Manifest No.
Phone:
77911
Contact: Mr. W. Soott Snow, PE
�
Contaminant: Non Haz VOCIa
Torrs Drums Pails Sacs Yards Other:
Phone: [phone]
Truck #: a % 6 Contact: Tony Lusher
Evo Corporation
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
ManifestLoad # ' 10
w.. _MINAN., i ®
Oracle Flexible
Generator: Phone:
220 East 0 0 oa
Site Address:
City/State: Winston-Salem., NC 27105 Contact:
Mr. W. 800tt Snow, PE
MA ERIAD SCRIPTfON GUANTICUIIElC�I -
Gross Weight (Ibs): 7 6 6 "7 0 Material: Soil
Empty Weight (lbs): J3 a g 0 n Contaminant: Ron Haz VOC's
Net Weight (lbs):
Quantity 3, as ons Drums Pails Sacs Yards Other:
gz�.
cam-,- _ _ _. _ _ - _L-
Transporter:
Evo Corporation Phone: [phone]
Truck #: C f'(p. Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Evo Project #: 121613
Phone: [phone]
Contact: Tony Disher
1 certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal In a manner that has been authorized by the State of North Carolina.
White/Facility Canary/invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, Z008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Oracle Flexible Packagina LLFllex
Generator:
0 0 Road
Site Address:
City/State: Winston-Salem, NC 27105
Gross Weight (lbs): Material:
Empty Weight (lbs): 3Q9 rQ Contaminant:
Net Weight (lbs):
Quantity Ton Drums
Manifest No.
Phone:
77912
-5878
Contact: Mr. W. Scott Snow, PE
Soil
Non Has VOC's
Pails Sacs Yards Other:
Transporter Evo Corporation Phone: [phone]
Truck #: r� �� 311 Contact: Tony Diisher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate. I
Driver Signature:
EVO CORPORATION
Date:
Evo Project #:
121613
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and 1 hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
T _
_
Facility Signature:
Date: li�J
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corpomuon, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
City/State: Winston-Salem, NC 27105 Contact: Mr. W. Scott Snow, PE
MAC ER1A DESCRIPTIOI/„UAITI� Wl�le „ '�
Gross Weight (lbs): tV 0
Empty Weight (Ibs): _ Sag (C2 0
Net Weight (lbs): 00
Quantity
Material:
'ti i
Contaminant: Non Haz VOC'e
Tons Drums Pails Sacs Yards Other:
Transporter: Evo Corporation Phone: [phone]
Truck #: ) Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Sionature:
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Date: l� I ► (D
Evo Project #: 121613
Phone: [phone]
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or dlsposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Involce Goldenrod/Generator Pink/Carrier
Evo Corpomtion, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator:
Site Address:
City/State: inston alem, NC 2 105
Manifest No. 77915
Phone:
Contact: Mr. W. Scout Snow, PE
Gross Weight (lbs): ���Ja�� Material: Soil
Empty Weight (lbs): . Contaminant: Ran Haz VOC's
Net Weight (lbs):
Quantity l Ton Drums Pails Sacs Yards Other:
BRANS OiTERIIVFORNfA1'IO1V
Transporter: Eva Corporation Phone: [phone]
Truck #: 9 n L q Contact: Toffy Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Driver Signature: Ih k�� Date: loot
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
/
Facility Signature: Date: CA
A
r
White/Facility Canary/Invoice Goldenrod/Generator PInk/Can ier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Oracle Flexible Packaging/ LLFlea
Generator:
a:zqj zaat roto moaa
Site Address:
City/State: Winston-Salem, RC 27105
Gross Weight (lbs):
Empty Weight (lbs):
Net Weight (lbs): W)
Quantity 'v
Transporter: Evo Corporation
Truck #: 41:)
Material:
Manifest No. 7 7 914
336-777-5878
Phone:
Contact: Mr' W. Scott Snow, PE
Son
Contaminant:
Ron Haz VOC's
Tons Drums Pails Sacs Yards Other:
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #: 121613
all
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator:
Site Address:
City/State: Winston-Salem, NC 27105
Manifest No. 7 7 913
Phone:
Contact:
Mr. W. So -oft Snow, PE
Gross Weight (lbs): ('a ! (AD Material: soil
Non Haz VOC'sEmPtY Weight (lbs):
Net Weight (lbs): � {�
Quantity Tons Drums Pails Sacs Yards Other:
Transporter: Evo Corporation
Truck #:
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
Facility Signature:
Date: q, W
I WE
White/Facility Y Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load #
Generator: 220 East Polo Miad
Site Address:
City/State: Winston-Salem, N 7105
Gross Weight (lbs): 21a) S 0
Empty Weight (Ibs): �}3� a
Net Weight (lbs):
Quantity
Transporter. Evo Corporation
Truck #:
Material:
Manifest No.
Phone:
77919
Contact: Mr. W. Scott Snow, PE
Zm
Contaminant:
Non Haz VOC's
Tons
Drums Pails Sacs Yards Other:
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
EVO CORPORATION
1703 Vargrave Street
Winston-Salem, NC 27107
Evo Project #:
121613
Phone: (33 ) 725-5844
Contact: Tonv Disher
I certify that the carrier has delivered the materials described above to this facility, and I hereby accept this
material for treatment and/or disposal in a manner that has been authorized by the State of North Carolina.
White/Facility Canary/Invoice Goldenrod/Generator Pink/Carrier
Evo Corporation, 2008

EVO CORPORATION
1703 Vargrave Street, Winston-Salem, NC 27107
www.evocorp.net
NON -HAZARDOUS MATERIALS MANIFEST
Load # Manifest No. 77922
01
GEIERATO, IN1=0RMAT�ON hM
Oracle Flexible Packaging/ LLFIex 336-777-5878
Generator:
;eAu r;a vE .Colo moan
Site Address:
City/State: Winston-Salem, NC 27105
Gross Weight (Ibs)
Phone:
Contact: Mr. W. Scott Snow, PE
MATERIA�DISCRIP�T�ON�I�QUANTI � �I�WEIGHT.�� �� -
'� Mo
Material:
Empty Weight (Ibs): 2A:Jq Ln Contaminant:
Net Weight (Ibs): r�
Quantity &'�, l � Tons
Hon Haz VOC's
Drums Pails Sacs Yards Other:
RA S)?OI�TE : INF�RMi4TlON �,;, .
Transporter: Evo Corporation
Truck #: A� t ?
Phone: [phone]
Contact: Tony Disher
As the transporter, I certify that the materials described above being shipped under this non -hazardous
materials manifest are properly classified, packaged, labeled, secured and are in proper condition for transport
in commerce under the applicable regulations governing transportation, and I hereby receive this material for
delivery to the facility designate.
Evo Project #: 121613
EVO CORPORATION
1703 Vargrave Street Phone: [phone]
Winston-Salem, NC 27107
Contact: Tony Dasher
Eva Corporation, 2008

0
i°N')ra 3
109 U Pull It Ticket No :79557
3459 Thomasville Rd Date :12/9/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
NEW
Truck : EVODUMPTF
Adjustment:
Weigh Master: CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver:
Gross: 58000 lb Scale 1
Tare: 0 lb Scale 1
Net: 0 lb
0.000 to
In 10:34 am
Out 12:00 am
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST
to 0.0000
22
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) par este media certifico que todos los articulos vendidos can esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.

-- �t0 r 1- �0a S
109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer. NEW
NEW
Ticket No :79562
Date :12/9/16
Phone :[phone]
Fax :[phone]
Truck EVODUMPTF Gross: 5BO20 lb Scale 1 In 12:11 pm
Tare: 0 lb Scale 1 Out 12:00 am
Adjustment:
Weigh Master: CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Net: 0 lb
0.000 to
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL OTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST
to 0.0000
99
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. l also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiron esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
NORTH OUNA
pusuc {ARE{ SG J E 330. 2017
L{CEPISE EV GH 998
AU ��

tit 1'3 —t `►` ° a
109 U Pull It Ticket No :79580
3459 Thomasville Rd Date :12/9/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
► ATA
Truck EVODUMP
Gross :
46060
lb
Scale 1
In 2:20 pm
Tare:
0
lb
Scale 1
Out 12:00 am
Net:
0
lb
Adjustment:
0.000
to
Weigh Master. CHAS
CHASITY BAUGHMAN
Material $
0.00
Delivery $
Misc $
0.00
0.00
Remarks: Thanks
Tax $
0.00
Driver.
Total $
0.00
0.00
0.00
MATERIAL QTY
UNIT-$
DELIVERY-$
MISC-$
TAX-$
TOTAL-$
TEST to
0.0000
0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
NORTH CAROLINA
PUBLIC WE1 HMASTER
LICENSE E)IPI1UNE 30, 201 Q

Z1�, 13
109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer. NEW
NEW
Ticket No :79442
Date :12/7/16
Phone: [phone]
Fax :[phone]
Truck EVO Gross : 44720 lb Scale 1 In 10:45 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. LORI LORI YOUNG Material $ 0.00
Remarks: Thanks Delivery $ 0.00
Misc $ 0.00
Tax $ 0.00
Driver.
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
_,AXAN

•.,�.lu �3 �I� �jrk
109 U Pull It
3459 Thomasville Rd
Ninston Salem, NC 27107
;.ustomer. NEW
NEW
Ticket No :79458
Date :1217/16
Phone: [phone]
Fax :[phone]
Truck EVO Gross : 46120
lb
Scale 1
In 12:29 pm
Tare: 0
lb
Scale 1
Out 12:00 am
Net: 0
lb
Adjustment: 0.000
to
Weigh Master: LORI LORI YOUNG
Material $
0.00
Delivery $
0.00
Remarks: Thanks
Misc $
0.00
Tax $
0.00
Driver
Total $ 0.00
0.00
0.00
MATERIAL CITY UNIT $ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, i certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) par este medio certifico que todos los articulos vendidos con esta carga de Is chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiron esto trabaJa con Is imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de Is ley.
oU0
NOR11A iM q Al
pUs4lO 1UNE 30�
ILICEN� --
It�N�� 5S I EO

109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer. NEW
NEW
Ticket No :79470
Date :12/7/16
Phone:[phone]
Fax:[phone]
Truck EVO Gross: 51040 lb Scale 1 In 2:53 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. LORI LORI YOUNG Material $ 0.00
Delivery $ 0.00
Remarks: Thanks Misc $ 0.00
Tax $ 0.00
Driver Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas llena de la ley.
HORN CAROUNA
gUBLIC WEIGNMASTE11
LICENSE EAMIRES DUNE 20117
36M
INV g U ESS SI

109 U Pull It Ticket No :79486
3459 Thomasville Rd Date :12/8116
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
Truck EVO Gross: 78480 lb Scale 1 In 8:35 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL CITY UNIT $ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. 1
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmac€on) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 t€ran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local pare desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilene de la ley.
)zl(08
NORiH C�L
PUBLIC WEI 3608
LICENSE JUNE
INV 14 SI

I J9 U Pull It
Ticket No :79502
3459 Thomasville Rd
Date :12/8/16
Phone: [phone]
/inston Salem, NC 27107
Fax :[phone]
7ustomer. NEW
IEW
Truck EVO
Gross: 79760
lb
Scale 1 In 10:30 am
Tare: 0
lb
Scale 1 Out 12:00 am
Net : 0
lb
Adjustment
0.000
to
Neigh Master CHAS CHASITY BAUGHMAN
Material $ 0.00
Delivery $ 0.00
Misc $ 0.00
Remarks: Thanks
Tax $ 0.00
Total $ 0.00
Driver.
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ M1SC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. 1
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Puil-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (aftrmacion) por este medio certifico qua todos los articulos vendidos con ests carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 bran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local Para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
)z1co13
NORTH CAROLINA
PUBLIC WEIGHMASTER
LICENSE
c I OUNE 30, 2017
'A33M
SIhNALID SIGNED
_

109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer. NEW
NEW
Ticket No :79515
Date :12/8/16
Phone :[phone]
Fax :[phone]
Truck EVO
Gross: 82080
€b
Scale 1
In 12:05 pm
Tare: 0
lb
Scale 1
Out 12:00 am
Net: 0
lb
Adjustment
0.000
to
Weigh Master: CHAS CHASITY BAUGHMAN
Material $
0.00
Delivery $
0.00
Remarks: Thanks
Misc $
0.00
Tax $
0.00
Driver
Total $
0.00
0.00
0.00
MATERIAL QTY
TEST
UNIT $ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
to 0.0000
l w
0.00 0.00
By signing this document, I certify that all items sold in this load,of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaraclon (afirmacion) par este media certifico que todos los articulos vend€dos can esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun art€culo robado. Tambien
entiendo que 109 bran esto trabaja con €a imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado at grado mas Ilena de la ley.
izl(ol3
N0R��GH �`SSp' 2$99S
ISCENs�' 6P�G �G�Ep
p�DV S
1

J09 U Pull It Ticket No :79534
3459 Thomasville Rd Date :12/8/16
Phone: [phone]
Ninston Salem, NC 27107 Fax :[phone]
..ustomer. NEW
4EW
Truck EVO Gross: 80300 lb Scale 1 In 2:16 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN Material $ 0.00
Delivery $ 0.00
Remarks: Thanks Misc $ 0.00
Tax $ 0.00
Driver Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiron esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robs y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
izIU13

109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer: NEW
NEW
Truck : EVO
Adjustment:
Weigh Master. LORI LORI YOUNG
Remarks: Thanks
Driver:
Ticket No :79447
Date :12/7/16
Phone: [phone]
Fax :[phone]
Gross: 70300 lb Scale 1 In 11:14 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
0.000 to
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obiiendos lagimente y no son robados. Entlendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilene de la ley.
�big" OpROLINA
GHMASTER
t

109 U Pull It I'zl l°!3
Ticket No :79464
3459 Thomasville Rd vZ���. 3 r Date :1217/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW
Truck EVO Gross: 68540 lb Scale 1 In 1:09 pm
Tare: 0 lb STORED Out 12:00 am
Net: 0 lb
Adjustment 0.000 to
Weigh Master. LORI LORI YOUNG Material $ 0.00
Delivery $ 0.00
De
Remarks: hanks Misc $ 0.00
Tax $ 0.00
Driver.
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Mena de la ley.
NORM OUNA
AUSLIC VVE GGHMASTER
La x �S JUNE 30, 2�
�—

I III
109 U Pull It Ticket No :79471
3459 Thomasville Rd 2(z'33 Date :12/7/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
NEW
Truck EVO Gross: 78620 lb Scale 1 In 2:58 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master: LORI LORI YOUNG Material $ 0.00
Remarks: Thanks Delivery $ 0.00
Misc $ 0.00
Tax $ 0.00
aver:
Total $ 0.00
0.00
0.00
MATERIAL OTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos ios articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
IRoura
p.12211 N�SYER� A $
taES utyE 3a�
1.10EtAse G
11�NiD U
� S1

109 U Pull It � 0&t3 Ticket No :79485
3459 Thomasville Rd Date :12/8/16
Phone :[phone]
Winston Salem, NC 27107 �Z %'~Q. J� 4 4 Fax :[phone]
Customer. NEW
NEW
Truck EVO Gross: 75720 lb Scale 1 In 8:21 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN Material $ 0.00
Delivery $ 0.00
Remarks: Thanks Misc $ 0.00
Tax $ 0.00
Driver:
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
NORM GA013,IA
12UBUC VJEZG INE I . 2017
LIGENSix�'1RES J�
1M►►►L1D U St

109 U Pull It `-` Ticket No :79453
3459 Thomasville Rd r" + Date :12/7/16
Phone :[phone] E°
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW ,
Truck EVO Gross: 72760 lb Scale 1 In 12:05 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment 0.000 to
Weigh Master. LORI LORI YOUNG
Remarks: Thanks
Driver:
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT $ DELIVERY-$ M1SC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun aniculo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
1Zlcv13
NORTH CAROLINA
PUBLIC WEIGHMASTER
LICENSE EXPIRES JUNE 3 20171
ji;l�4SITYUIA GN . !,3i998
INVALID UNLESS S

109 U Pull It Ticket No :79466
3459 Thomasville Rd Date :1217116
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
BA"AA
Truck EVO Gross: 72960 lb Scale 1 In 2:35 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master: LORI LORI YOUNG Material $ 0.00
Remarks: Thanks Delivery $ 0.00
Misc $ 0.00
Tax $ 0.00
Driver:
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, 1 certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
i21 (V 15
G�oult
NpRTH
590
IRES DUNE
C CTY Bp GH
AU SS Sl D
1

109 U Pull It ,
Ticket No :79451
�`3459 Thomasville Rd
Date :12/7/16
Phone :[phone]
Winston Salem, NC 27107
Fax :[phone]
Customer. NEW
NEW
Truck EVO
Gross:
84640
lb Scale 1 In 11:47 am
Tare:
0
lb Scale 1 Out 12:00 am
Net:
0
lb
Adjustment:
0.000
to
Weigh Master: LORI LORI YOUNG Material $ 0.00
Remarks: Thanks Delivery $ 0.00
Misc $ 0.00
Tax $ 0.00
Driver: Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
NORTH WOUNA
PUBLIC WEIGHMP
LICENSE EXPIRES JUN 30.20
BAU 3i,9Dr?�
lNV UN SIG -

109 U Pull It Ticket No :79465
3459 Thomasville Rd Date :12/7/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
aayny
Truck EVO Gross:
84080
lb
Scale 1
In
1:54 pm
Tare:
0
lb
Scale 1
Out
12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. LORI LORI YOUNG
Remarks: Thanks
Driver:
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaraclon (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 bran de u esto no desechara ningun aniculo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
/') /('0 /�
cOR"A /
PUBUIG�dUNE 30,2017
L1cratm 590
lNV U SIG

109 U Pull It Ticket No :79488
3459 Thomasville Rd Date :12/8/16
Phone :[phone]
✓llinston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW
Truck EVO Gross: 78920 lb Scale 1 In 8:49 am
1 Tare: 0 lb Scale 1 Out 12:00 am
IV ok
Adjustment:
Reigh Master: CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Net, 0 lb
0.000 to
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certiflco que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 bran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local pare desalentar el robs y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilene de la ley.
�Ib MJ CAROL►M
I UBLItrw
UCENSE EXPIRES d[1NE
1TY UGH
INVAm_ LE S' IGNEO'

109 U Pull It
3459 Thomasville Rd
Winston Salem, NC 27107
Customer. NEW
NEW
Truck EVO -4
Adjustment
Weigh Master. CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver:
MATERIAL QTY
TEST
Ticket No :79501
Date :12/8/16
Phone :[phone]
Fax :[phone]
Gross: 78180 lb Scale 1 In 10:12 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
0.000 to
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
UNIT-$ DELIVERY $ MISC-$ TAX-$ TOTAL-$
to 0.0000
AM
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that 1 drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio cerbfico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 firan esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado a! grado mas Ilena de la ley.
/C JJ6/1,
NORTH CAROLINA
PUSUC WEIGHMASTER
LICENSE EXPIRES JUNE 30, 2011
tilt RAU 38998,
I
SIG
r`

109 U Pull It Ticket No :79512
3459 Thomasville Rd Date :12/8/16
Phone :[phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
NEW
Truck EV0216 Gross: 77240 lb Scale 1 In 11:45 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL CITY UNIT $ DELIVERY $ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
� Cp�ptaNA
Nt)RWEIG� 7
,pUgt.IC I>-S SUNE 30,
so
ucENS
� UNLE IGN

,09 U Pull It Ticket No :79528
3459 Thomasville Rd Date :1218/16
Phone :[phone]
Vinston Salem, NC 27107 Fax :(336)7B8`1368
`,ustomer. NEW
I EW
Truck EVO216 Gross: 78640 lb Scale 1 In 1:40 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment 0.000 to
Neigh Master. CHAS CHASITY BAUGHMAN Material $ 0.00
Delivery $ 0.00
Remarks: Thanks Misc $ 0.00
Tax $ 0.00
Driver. Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaraclon (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.

109 U Pull It Ticket No :79490
3459 Thomasville Rd Date :12/8/16
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW
Truck EVO Gross: 79980 lb Scale 1 In 9:10 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) par este media certifico que todos los articulos vendidos can esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la fey.
NOM OUNA
PuBlAM
UGEN��
INVA1-ID U ss SIGN

109 U Pull It Ticket No :79506
3459 Thomasville Rd Date :12/8/16
Phone :[phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW
Truck : EVO
Adjustment
Weigh Master. CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver:
Gross: 78060 lb Scale 1
Tare: 0 lb Scale 1
Net: 0 lb
0.000 to
In 10:53 am
Out 12:00 am
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL CITY UNIT $ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that 1 drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) par este media certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obfiendos lagimente y no son robados. Entiendo que 109 bron de u esto no desechara ningun aniculo robado. Tambien
entiendo que 109 bran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local pars desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de Ea ley.
✓2IL �. l
NORTH MOLINA
PUBLIC WEIG sUHM EPA
LICENTMOwl
BAUO . 36998
iaVALI UN SIGNED

109 U Pull It Ticket No :79517
1459 Thomasville Rd Date :12/8/16
Phone :[phone]
Ninston Salem, NC 27107 Fax :[phone]
;ustomer. NEW
JEW
Truck EV0217 Gross: 77320 lb Scale 1 In 12:20 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN Material $ 0.00
Remarks: Thanks Delivery $ 0.00
Misc $ 0.00
Tax $ 0.00
Driver Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT $ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, i can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 bron de u esto no desechare ningun articulo robado. Tambien
entiendo que 109 than esto trabeja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas liena de la ley.
pusvG'��s�'30'2as�
t

109 U Pull It Ticket No :79532
3459 Thomasville Rd Date :12/8/16
Phone :[phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
NEW
Truck EV0217 Gross: 80700 lb Scale 1 In 1:58 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master: CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL CITY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos las articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun aniculo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.
NDRjH CAROUI R
4�''EXP g, S �E 3 91g
L.1 N VG
C SIGNF�
ALt U t

109 U Pull It Ticket No :79543
3459 Thomasville Rd Date :12/8116
Phone: [phone]
Winston Salem, NC 27107 Fax :[phone]
Customer: NEW
VATZA
Truck EVO Gross: 67960 lb Scale 1 In 3:24 pm
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master. CHAS CHASITY BAUGHMAN Material $ 0.00
Remarks: Thanks Delivery $ 0.00Misc $ 0.00
Tax $ 0.00
Driver.
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
0.00 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de Is chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con Is imposicion de ley fereral y ley estado (derecho public local pars desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas llena de Is ley.
t Ili cARottNA
pu 1.1G 1 �Jdti 30�Z01
ENS sss

109 U Pull It Ticket No :79551
3459 Thomasville Rd Date :12/9/16
Phone:[phone]
Winston Salem, NC 27107 Fax :[phone]
5
Customer. NEW
NEW
Truck EV0217 Gross :
82180
lb
Scale 1
In
8:41 am
Tare:
0
lb
Scale 1
Out
12:00 am
Net: 0 lb
Adjustment" 0.000 to
Weigh Master: CHAS CHASITY BAUGHMAN Material $ 0.00
Delivery $ 0.00
Remarks: Thanks Misc $ 0.00
Tax $ 0.00
Driver:
Total $ 0.00
0.00
0.00
MATERIAL OTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medlo certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 tiran esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.

109 U Pull It Ticket No :79555
3459 Thomasville Rd Date :12/9/16
Phone :[phone]
Winston Salem, NC 27107 Fax :[phone]
Customer. NEW
Truck EV0217 Gross: 78480 lb Scale 1 In 10:16 am
Tare: 0 lb Scale 1 Out 12:00 am
Net: 0 lb
Adjustment: 0.000 to
Weigh Master: CHAS CHASITY BAUGHMAN
Remarks: Thanks
Driver.
Material $
0.00
Delivery $
0.00
Misc $
0.00
Tax $
0.00
Total $ 0.00
0.00
0.00
MATERIAL QTY UNIT-$ DELIVERY-$ MISC-$ TAX-$ TOTAL-$
TEST to 0.0000 0.00
M1 r� a is
By signing this document, I certify that all items sold in this load of scrap metal were obtained legally and are not stolen. I
understand that 109 U-Pull-It will not accept any stolen items. I also understand that 109 U-Pull-It works closely with local and state
law enforcement to deter theft and if any items that I drop off are found to be stolen, I can and will be prosecuted to the fullest
extent of the law.
Firmando esta delaracion (afirmacion) por este medio certifico que todos los articulos vendidos con esta carga de la chatarra
fueron obtiendos lagimente y no son robados. Entiendo que 109 tiron de u esto no desechara ningun articulo robado. Tambien
entiendo que 109 than esto trabaja con la imposicion de ley fereral y ley estado (derecho public local para desalentar el robo y si
calquier anticulo que yo deje es encontrado robado puedo y ser procesado al grado mas Ilena de la ley.

Appendix C
Photographs
Hart & Hickman, PC

Photograph 1: Former infiltration gallery area
1", 00
tIA
ri
x ,! ¢ 4. • as `"r , �. � > F +�,,' �i
s',r��,s•A i`'f+'
s 4;.1 ti `,fir'. � � rY ,: � 'T ♦ �' .. ,� '€,r�tj�%,.� may., ,..4
I Oil,
°�""�. 1, - b._ •� ey?`t� �� i' A `�ti
Photograph 2: Collection of TCLP sample prior to gallery excavation. HDPE liner
encountered approximately 30-inches below grade, gravel located below liner.
haft
. ,,} '4 2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
a l '"%• hickman Charlotte, NC 28203 Winston Salem, North Carolina
W 704.586.0007(p) 704.586.0373(f)

F
LLS
Photograph 3: Gravel, geotextile liner and two 4" dia. diffusion pipes visible in former gallery.
Photograph 4: Excavation following removal of liner, gravel and all piping.
14 2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart � hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

Q
s
C
Photograph 5: 2-inch dia. gallery influent piping cut and grouted prior to gluing on PVC cap.
Also visible is 1-inch level sensor electrical conduit prior to removal.
Photograph 6: 2-inch dia. gallery influent piping capped following removal of level sensor electrical conduit.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart � hickman Charlotte, NC 28203 Winston Salem. North Carolina
704.586.0007(p) 704.586.0373(f)

Photograph 7: Clean fill dirt being dumped into gallery excavation.
Photograph 8: Fill dirt being compacted in lifts.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart 'ti hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

Q
s
0
Photograph 9: Former infiltration gallery and surrounding area following
regrading of stockpiled overburden and application of seed and straw.
Photograph 10: Typical recovery well prior to monitoring well conversion. 2-inch vacuum assist line,
1-inch water discharge line and 3/4-inch electrical conduit are attached to 4" PVC "T" on well head.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart ''ti hickman Charlotte, NC 28203 Winston Salem, North Carolina
r' 704.586.0007(p) 704.586.0373(f)

Photograph 11: Former groundwater treatment system building. Air stripper towers visible through roof of building.
Photograph 12: Three air strippers in series with two activated carbon polishing
cylinders (just out of photo on right) prior to treated water discharge to infiltration gallery.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

Photograph 13: 2-inch dia. PVC vacuum assist lines to recovery wells.
Photograph 14: 2-inch dia. PVC vacuum assist lines following grouting and
installation of glue on PVC slip prior to being buried.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart O hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

Photograph 15: 1-inch dia. steel groundwater recovery lines into building following cutting, and grouting.
Photograph 16: 1-inch dia. groundwater recovery lines following installation of PVC caps.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart "sm hickman Charlotte, NC 28203 Winston Salem, North Carolina
W 704.586.0007(p) 704.586.0373(f)

Photograph 17: 1.5-inch dia. steel discharge line (wrapped in foam insulation) to gallery. Wood cover
leaning against building covered horizontal portion of piping on concrete slab.
Photograph 1 S: Discharge line to gallery cut loose and grouted to grade.
14 2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging — Plant 604
hart ONO hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

Photograph 19: Interior of well vault showing grouted electrical conduit, groundwater recovery and vacuum assist lines.
Photograph 20: Grouted and capped, groundwater recovery and vacuum assist line and grouted
electrical conduit. Locking expansion plug, brass lock and secured well tag installed on former
recovery well. 2' x 2' steel vault lid bolted down upon completion.
2923 S. Tryon Street, Suite 100 Oracle Flexible Packaging - Plant 604
hart 1 hickman Charlotte, NC 28203 Winston Salem, North Carolina
704.586.0007(p) 704.586.0373(f)

GW-59A COMPLIANCE REPORT FORM Permit # WQ0006992
(.Submit one each monitoring period with GW-59 firrmc.)
I
L V
Enter date monitoring results were due. `02/28/2017) Will this monitoring report (GW-59 and W-5 A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
X
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
If the answer to question 4 is °NO'; skip to section 8.
If "YES"
X
the answer to question 4 is list the affected wells individually with constitue'd concentration(s)
exceeding standards in the space provided below:
TN
Q
YES
NO
5
For the constituents identified in question 4 above, have standards been exceeded sly for the
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES" list in the space provided below, each well with onstituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
g'�- .4A, 2-2Z_
-
Signature of Perrnittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(AV-59 1 12/8/2003

SUBMIT FORM ON YFI I OW PAPFR ONI Y
GROUNDWATER QUALITY MONITORING:
EPARTMENTOF ENVIRONMENT& NATURAL RESOURCES
COMPLIANCE REPORT FORM
IM1617
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Pnnt Cleanyor type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor El Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
`.
If WELL
ELL ID NUMBER (from Permit): Duke Power Well
Date sample collect 01/24/2017
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diamete .
pH 6.41 units Temp. 15.4 °C
DRY at
Depth to Water Level: 11.07 ft. below measuring point
Screened Interval: 18.9 ft.
to 28.9
ft. Spec. Cond. liMhos
time
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
sampling,
check
Volume of water pumped/bailed before sampling:
35.0 gallons
Appearance Clear
here:
Samples for metals were collected unfiltered: DYES
❑ NO and field acidified: ❑ YES
El NO
❑
LABORATORY INFORMATION
Date sample analyzed: 01/24/2017
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and Colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone <5.0 (All in parts per billion)
pH (when analyzed) units
Ba - Barium
mg/I
Isopropanol <100
TOC mg/I
Ca - Calcium
mg/I
MEK <5.0
Chloride mg/I
Cd - Cadmium
mg/I
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen. Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
;Date)
pGW-59 Rev.1/2007

RESEARCh & ANAtyTICA[
LAbORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
(An Oracle 604 Prolec7, collected 24 JanuaU 2017)
Volatile Organics
Quantitation
Duke Power Well
EPA Method 8260 B
Limit
Parameter
(ppb)
{nob)
Acetone
5.0
BQL
Aaolein
100
BQL
Acrylenitrdc
100
BQL
Benzene
0.5
BQL
Bromobcmene
0.5
BQL
Bromocbloromedume
0.5
BQL
BromodichImcancthane
05
BQL
Brcmofcrm
10
BQL
Bramomethane
1.0
BQL
2-Bumnone
5.0
BQL
Carbon Disulftde
5.0
BQL
Carbon Tetrachloride
0.5
BQL
Chlorobenzene
05
BQL
Chloroethane
1 0
BQL
2-Chloroethy) vinyl ether
50
BQL
Chloroform
05
BQL
Chloromethane
1.0
BQL
2-Chlcrotoluene
0.5
BQL
4-Chlorotoluene
05
BQL
Cis-1,2-Dichloroethene
0.5
BQL
Cis-1,3-Dichloropropene
0.5
BQL
1,2-Dibrmoo-3-Chloropropanc(DBCP)
5.0
BQL
1,2-Dibromoethane (EDB)
05
BQL
Dibromochloromethane
0.5
BQL
Dibromornethane
0.5
BQL
1,2-Dichlarobemene
0.5
BQL
1,3-Dichlorobenzerre
0.5
BQL
1,4-Dichlorobenzene
0.5
BQL
1,1-Dichloroethane
0.5
BQL
1,2-Dichloroethane
05
BQL
1,1-Dichloroethene
0.5
BQL
Dichleroflourometharnc
0.5
BQL
1,2-Dichloropropane
0.5
BQL
1,3-Dichloropropane
0.5
BQL
2,2-Dichlorepropanc
0.5
BQL
1, I-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hexachlorobutadiene
0.5
BQL
2-Hexanone
5.0
BQL
IPE
0.5
BQL
I-Propylbenzene
0.5
BQL
4-Methyt-2-Pentanone
5.0
BQL
Methyl Iodide
1 0
BQL
Methylene Chloride
50
BQL
MTBE
0.5
BQL
Naphthalenc
0.5
BQL
N-Butylbemene
0.5
BQL
N-Propyllicruene
0.5
BQL
p-Isopropyltoluene
0.5
BQL
Sec-Butyibenzene
0.5
BQL
Styrene
0.5
BQL
Ten-Butylbenzene
0.5
BQL
1,1.1,2-Tetrarhloroethane
0.5
BQL
1, 1,2,2-Tetarhloroethane
0.5
BQL
Tetmrhloroetherte
0.5
4.04
Toluene
0.5
BQL
Trans-1,2-Dirhloroethene
0.5
BQL
Trans-1,3-Dichloropropene
0.5
BQL
Trans- l,4-Dichloro2-butene
5.0
BQL
12,3-Trichlorobcnzene
0.5
BQL
1,2,4-Tnchlmobeazerte
0.5
BQL
1,1,1-Tnchloroethane
0.5
BQL
1,1,2-Trichloroethane
0.5
BQL
Trirhloroethene
0.5
BQL
Trichlorofluommedme
0.5
1.79
12,3-Trichloropropane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-Trimethylbenzene
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
Total Xylenes
1.0
BQL
Isopropanol
100
BQL
Isopropyl Acetate
1.0
BQL
Dilution Factor
I
Sample Number
30024-01
Sample Date
01/24/17
Sample Time (brs)
1205
} ANAtYJa„/1
I '•e 'RfiD ANP�' J
/ti///uaawa�
BQL = Below Quantitation Limits Quantitation limits must be multiplied by dilution factor b
PP - puts
per billion (ppb)

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
Weather
January 24, 2017
Date
Monitoring Well No..
Duke Power
MW-10
MW-14
Total Depth (FT.)
28.91
30.12
30.14
Surface Depth (FT.)
11.07
Water Depth (FT.)
17.84
Diameter (1N.)
4"
2"
2"
Conversion Factor
0.65
0.16
0.16
Well Volume (GAL)
11.60
Volume (GAL) X 3
34.79
Bails )
140
Purge Date
01/24/17
Purge Time (hrs.)
1 143
Purge Method
Bailer
Bailer
Bailer
Volume Removed (GAL.)
35.00
Sampling Dote
01/24/17
Sampling Time (hrs.)
1205
Sampling Method
Bailer
Bailer
Bailer
B (Standard Units)
6.41
Temperature (EC)
15.4
Conductivity (µmhos/em)
206
bservationslSam lin
Clear

Research & Analytical
Laboratories, Inc.
Analytical / Process Con.sultalions
Phone [phone]
CHAIN OF CUSTODY RECORD
It atcr
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Comp:un Oracle 604
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Cite, State, Zip
Sampler Name (Ple,• .;t* Pr•int) /)
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Conlact
Phone
Sampler Signature
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Removed
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S or \\
S:unple Location / I.D.—
Re( Nested AnAN %is
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Received BN
Remarks:
Relinquished Its
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S:urllilo I onllx-rsMr—, t receil,l

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
-VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM'JOW
617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearty or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non-pischarge W00006992 UIC
Permit Name (if different):
NPDES ' ` ' °' - - - - Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
(from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 07/28/2016
FIELD ANALYSES:
WAS
ell Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.55 units Temp. 20.4 °C
DRY at
Depth to Water Level: 11.33 ft. below measuring point
Screened Interval: 18.9 ft.
to 8.9
ft. Spec. Cond. µMhos
time of
sampling,check
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
Volume of water pumped/bailed before sampling: 35.0 gallons
Appearance Clear
here:
Samples for metals were collected unfiltered: ❑YES ❑ NO
and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 07/28/2016
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate-'
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/1
Al -Aluminum crD n C at'g/I
Acetone 106 (All in parts per billion)
pH (when analyzed) units
Ba - Barium
mg/1
Isopropanol <100
TOC mg/I
Ca - Calcium
mg/I
MEK <5.0
Chloride mg/I
Cd - Cadmiym .
mg/I
" Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/1
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen: NH3as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IM16117
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ff.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit W00006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: EYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/l
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N', Ammonia Nitrogen, Total)
Mn - Manganese
mg/1
, method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IM1617
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Wonston-Salem NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
H units Tem °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: EYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; NH3as N, Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit # W00006992
(Submit one each monitoring period with G'N' 59 forms.)
1
Enter date monitoring results were due. (_ 08/30/20161 Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is `YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is `YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the Dermittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance GW-59A) is true and complete to the best of my knowledge.
eReport
/' "'� �' v 1 �� T Z2�J l
Signature of Perrnittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(:N'-59 % 12/8/2003

RESEARCh & ANA1yTICAt
LAbORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
(An Oracle 604 Project. collected 28 July 2016)
1. Volatile Organics Quantitation Duke Power Well
EPA Method 8260 B Limit
Parameter (pph) (Dph)
Acetone
5.0
106
Acrolein
100
BQL
Acrylonitrile
100
BQL
Benzene
0.5
BQL
Bromobenzene
0.5
BQL
Bromochloromethane
0.5
BQL
Bromodichloromethane
0.5
BQL
Bromoform
1.0
BQL
Bromomethane
1.0
BQL
2-Butanone
5.0
BQL
Carbon Disulfide
5.0
BQL
Carbon Tetrachloride
0.5
BQL
Chlorobenzene
0.5
BQL
Chloroethane
1.0
BQL
2-Chloroethyl vinyl ether
5.0
BQL
Chloroform
0.5
BQL
Chloromethane
1.0
BQL
2-Chlorotoluene
0.5
BQL
4-Chlorotoluene
0.5
BQL
Cis-1,2-Dichloroethene
0.5
BQL
Cis- 1,3-Dichloropropene
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5.0
BQL
1,2-Dibromoethane (EDB)
0.5
BQL
Dibromochloromethane
0.5
BQL
Dibromomethane
0.5
BQL
1,2-Dichlorobenzene
0.5
BQL
1,3-Dichlorobenzene
0.5
BQL
1,4-Dichlorobenzene
0.5
BQL
1,1-Dichloroethane
0.5
BQL
1,2-Dichloroethane
0.5
BQL
1,1-Dichloroethene
0.5
BQL
Dichloroflouromethane
0.5
BQL
1,2-Dichloropropane
0.5
BQL
1,3-Diddoropropane
0.5
BQL
2,2-Dichloropropane
0.5
BQL
1,1-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hexachlorobutadiene
0.5
BQL
2-Hexanone
5.0
BQL
IPE
0.5
BQL
I-Propylbenzene
0.5
BQL
4-Methyl-2-Pentanone
5.0
BQL
Methyl Iodide
1.0
BQL
Methylene Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzene
0.5
BQL
N-Propylbenzene
0.5
BQL
p-Isopropyltoluene
0.5
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
Tert-Butylbenzene
0.5
BQL
1, 1, 1,2-Tetrachloroethane
0.5
BQL
1,1,2,2-Tetrachloroedme
0.5
BQL
Tetrachloroethene
0.5
BQL
Toluene
0.5
BQL
Trans-1,2-Dichloroethene
0.5
BQL
Trans-1,3-Dichloropropene
0.5
BQL
Trans-1,4-Dichloro-2-butene
5.0
BQL
1,2,3-Trichlorobenzene
0.5
BQL
1,2,4-Trichlorobenzene
0.5
BQL
1,1,1-Trichloroedwe
0.5
BQL
1,1,2-Trichloroethane
0.5
BQL
Trichloroethene
0.5
BQL
Trichlorofluoromethane
0.5
BQL
1,2,3-Trichloropropane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-Trimethylbenzene
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
Total Xylenes
1.0
BQL
Isopropanol
100
BQL
Isopropyl Acetate
1.0
BQL
Dilution Factor
1
Sample Number
22430-01
Sample Date
07/28/16
Sample Time (hrs)
1358
�,b �GYji
BQL = Below Quantitation Limits Quantitation limits must be multiplied by dilution factor ppb = parts per billion (ppb)

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
July 28, 2016
Weather Clear 92°F Date
Monitoring Nell No..
Duke Power
MW-10
Mai-14
Total Depth (F'1'.)
28.91
30.12
30 14
Surface Depth (FT.)
11.33
Vater Depth (FT.)
17.59
Diameter (IN.)
4"
2"
2"
Conversion Factor
0.65
0 16
0.16
dell Volume (GAL.)
11,42
Volume (GAL.) X 3
34.28
Bails (L)
138
Purge Date
07/28/16
Purge'fime (hrs.)
1339
Purge Method
Railer
Bailer
Railer
Volume Removed ((.'At,.)
35.00
Sampling Date
07/28/16
Sampling Iime(hrs.)
1358
Sampling Method
Railer
Bailer
Bailer
pil (Standard Units)
6.55
Temperature (F.(
20.4°('
Conductivity (pmhos/cm)
<10
()bsenations\Sampling
Clear

Research & Analytical
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�' Anal}tical / Process Consultations
II Phone [phone]
Company- y
Oracle 604
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CHAIN OF CUSTODY RECORD
Water / Wastewater I Miser
Job No.
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Project Groundwater
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Sam pier Name (�17seprmt)
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Sampler Signature
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I Re* .rvcd A Iatf ix Ssmp'_e Location / I.D.
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Relinquished By— I Date/Time I "/I Received By
W _Dine Power W ll � _� � i 4 I
—TB�
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On j I Sample Temperature at receipt a Vj °C
RJR / 8260, Cond
TB

SUBMIT ON YELLOW PAPER ONLY " oV v
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
«
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date,. 10/31/2016
Facility Name: Oracle Flexible Packaging
- Polo Road Complex
Non -Discharged 1I[ UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke
Power Well
Date sample collected: 4/26/2016 FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 00400: 6.33 units Temp. 000lc 16.0 °C
DRY at
Depth to Water Level 82546: 11.82 ft. below
measuring point
Screened Interval: 18.9 ft. to
28.9 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling:
33.33
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered:
❑ YES ❑
NO and field acidified. ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/26/2016
Laboratory Name: Research & Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616
/100mL
Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300
mg/L
Al - Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC oomo
mg/L
Ca - Calcium oo916
mg/L MEK <5.0 µg/L
Chloride oosao
mg/L
Cd -Cadmium o1-
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic o1002
ug/L
Chromium: Total 01D34
ug/L Toluene <0.5 µg/L
Grease and Oils 00552
mg/L
Cu - Copper 01042 JUN Q 1 2016
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095
µMhos
K - Potassium'0607
mg/L VOC method # EPA 8260 B
Total Ammonia 00610
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee for Authorized Agent) Name and Title - Please print or Noe
GW-59 Rev.8/2013
of Permittee (or Authorized Aqent)
5_-.Z ( )
(Date)

SI IRMIT FC1RM nN YFI I OW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
• •
•
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, INC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 U►C
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon N Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. SCOtt Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name. Polo Road Complex
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-14
Date sample collected: 4/29/2016 FIELD ANALYSES:
WAS
Well Depth: 30.14 ft.
Well Diameter: 2.0 in.
pH 00400: 6.42 units Temp. 000i( 16.9 °C
DRY at
time of
Depth to Water Level 82546: 21.44 ft. below measuring point
Screened Interval: 20.0 ft. to
30.0 ft. Spec. Cond. 00094: µMhos
sampling,
Measuring Point is 0.75 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling: 3.25-Dry gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/29/2016
Laboratory Name: Research & Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31604 /100mL
Phosphorus: Total as P oo665
mg/L
(Note. Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC ooeeo mg/L
Ca - Calcium oo916
mg/L MEK <5.0 µg/L
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia ooelo mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L Vvc rtemoval io
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
+
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit):
MW-10
Date sample collected: 4/29/2016 FIELD ANALYSES:
WAS
Well Depth: 30.12 ft.
Well Diameter: 2.0 in.
pH 00400: 6.51 units Temp. 000lc 16.0 °C
DRY at
Depth to Water Level 82546: 21.20 ft. below
measuring point
Screened Interval: 20.0 ft. to
30.0 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 0.29 ft. above land surface
Relative M.P. Elevation: ft.
Odor 000m: None
check
Volume of water pumped/bailed before sampling:
3.75-Dry gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered:
❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/29/2016
Laboratory Name: Research & Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616
/100mL
Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P oo665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300
mg/L
Al - Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC oo68o
mg/L
Ca - Calcium oo916
mg/L MEK <5.0 µg/L
Chloride 00940
mg/L
Cd - Cadmium 01027
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00096
µMhos
K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia oo6lo
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen: NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only - . _ • • •
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or tvDe
S- Z
Agent) (Date)
GW-59 Rev.8/2013

GW-59A COMPLIANCE REPORT FORM Permit # WQ0006992
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. (_ 5/30/2016) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO" skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days; an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
Fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(;M -59 % 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 UIC
NPDES Other
Permit Name (if different):
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Polo Road Complex No. of wells to be sampled: 0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent Date sample collected:
FIELD ANALYSES:
WAS
As per letter dated June 23, 2010, from Mr. David Yount of Oracle Flexible Packaging to Mr. Ted
Bush (Section Chief - Aquifer Protection Section, DWQ),
operation of the groundwater
remediation system under Permit WQ0006992 has been temporarily suspended.
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ssolved Solids:Total 70300 mg/L Al -Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403 units Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC oomo mg/L Ca - Calcium 00916
mg/L MEK <5.0 µg/L
Chloride 00940 mg/L Cd - Cadmium 01027
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic 01002 ug/L Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552 mg/L Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 µMhos K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia oo6lo mg/L Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) Mn - Manganese 01055
ug/L method #
TKN as N 00625 mg/L Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
• .
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• • • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 UIC
Permit Name (if different):
NPDES Other
Facility Address. 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Polo Road Complex No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent Date sample collected:
FIELD ANALYSES:
WAS
As per letter dated June 23, 2010, from Mr. David Yount of Oracle Flexible Packaging to Mr. Ted
Bush (Section Chief - Aquifer Protection Section,
DWQ), operation of the groundwater
remediation system under Permit WQ0006992 has been temporarily suspended.
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N oo615
mg/L Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L Al -Aluminum oilo5
mg/L
pH (Lab) 00403 units Ba - Barium 01007
ug/L
TOC 00680 mg/L Ca - Calcium oo916
mg/L
Chloride 00940 mg/L Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos K - Potassium 00937
mg/L method #
Total Ammonia 00610 mg/L Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn -Manganese 01055
ug/L ,method #
TKN as N 00625 mg/L Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.8/2013
Signature of Permittee (or Authorized Aqent) (Date)

RESEARCh all. ANAIYYiCAt
LAbORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
(An Oracle 604 Proiect. collected 26 April 2016)
Volatile Organics Quantitation Duke Power Well
EPA Method 8260 B Limit
Parameter (ppb) (ppb)
Acetone
5.0
BQL
Acrolein
100
BQL
Acrylonitrile
100
BQL
Benzene
0.5
BQL
Bromobenzene
0.5
BQL
Bromochloromethane
0.5
BQL
Bromodichloromcthane
0.5
BQL
Bromoform
1.0
BQL
Bromomethnne
10
BQL
2-Butanone
5o
BQL
Carbon Disulfide
5.0
BQL
Carbon Tetrachloride
0.5
BQL
Chlorobenzene
0.5
BQL
Chloroethane
1.0
BQL
2-Chlaroethyl vinyl ether
5 0
BQL
Chloroform
03
BQL
Chloromethane
1.0
BQL
2-Chlorotoluene
0.5
BQL
4-Chlorotoluene
0.5
BQL
Cis-1,2-Dichlorocthene
0.5
BQL
Ci5-1,3-Dichlorapropene
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5 0
BQL
1,2-Dibromoethane (EDB)
0.5
BQL
Dibromochloromethane
0.5
BQL
Dibromamethane
0.5
BQL
1,2-Diehlorobenzene
0.5
BQL
1,3-Dichlorobenzene
0.5
BQL
1,4-Dichlorobenzene
0.5
BQL
1, I-Dichloroethane
0.5
BQL
112-Dichloroethane
0.5
BQL
1,1-Dichloroethene
0.5
BQL
DichloraFlouromethane
0.5
BQL
1,2-Dichloropropane
0.5
BQL
1,3-Dichloropropane
0.5
BQL
2,2-Dirhloropropane
0.5
BQL
1.1-D ichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hexachlorobutadiene
0.5
BQL
2-Hexanone
5.0
BQL
IPE
0 5
BQL
I-Propylbenzene
0.5
BQL
4-Methyl-2-Pentanone
5.0
BQL
Methyl Iodide
1.0
BQL
Methylene Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzme
0.3
BQL
N-Propylbenzene
0.5
BQL
p-Isopropyltoluene
0.5
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
Tert-Butylbenzenc
0.5
BQL
1.1, I;LTetrachloroethane
0.5
BQL
1,1,2,2-Tetmchloroedme
0.5
BQL
Tetrachloroethene
0.5
5.39
Toluene
0.5
BQL
Trans-1,2-Dichloroethene
0.5
BQL
Trans-1,3-Dichloropropene
0.5
BQL
Trans-1,4-Dirhloro-2-butene
5.0
BQL
1,2,3-Trichlorobenzene
0.5
BQL
1,2,4-Tnchl0robenz=e
0.5
BQL
1.1.1-Trichloroethane
0.5
BQL
1.1,2-Triehloroethane
0.5
BQL
Trichloroethene
0.5
BQL
Tnchlorofluoromethane
0 5
0.78
1,2,3-Trichloropropane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-Trimethylbcnzene
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
Total Xylenes
1.0
BQL
Isopropanol
100
BQL
Isopropyl Acetate
1.0
BQL
Dilution Factor
I
Sample Number
18236-01
Sample Date
04f26/16
Sample Time (hrs)
0805
b AtLlt... .'i.
;'=arcA34 =i
'•.rygED AN��� •`
BQL = Below Quantitation Limits ppb -parts per billion (ppb) J - Estimated concentration, present but below quartatation limit

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
April 26, 2016
Weather Partly Cloudy 49°F Date
Monitoring Well Na_
Duke PowerWell
Total Depth (FT.)
28.91
Surface Depth (F7.)
11.82
Water Depth (FT.)
I T09
Diameter (IN.)
4"
Conversion Factor
0.65
Well Volume (GAL)
11.11
Volume (GAI_) x 3
33.33
Bails
134
Purge Date
04/26/16
Purge Time (bra.)
0742
Purge Method
Bailer
Volume Removed (GAI_)
34
Sampling Dole
04/26/16
Sampling Time (bra.)
0805
Sampling Method
Bailer
R (Standard Units)
6.33
Temperature (EC)
16.0
Conductivity (pmhos/em)
249
hservationslSam lia
Clear

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
Water
/ Wastewater
Misc.
Company Oracle 604
Job No.
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Street Address
Project Groundwater
City, State, Zip
Sampler Name (Please Print)
Contact
Phone
Sampler Signature
c�
O
4..
Sample Number
(Lab Use Only)
Date
Time
Comp
Grab
temp
°C
Res.
C.
Chlorine
Removed
Y or iN'
Sample
Matrix
S or W)
Sample Location / I.D.
O
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Requested Analvsis
X
W
Duke Power Well
4
1
RJR / 8260, Cond
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TB
2
TB
Relir
W d By
D ePTime
Received By
Remarks:
Relinquished By
Date/Time
Re a ved By
On Ice
Sample Temperature at receipt a\ I (.

RESEARCh & ANALyTICAt
r 1 LABORATORIES, INC.
Anclytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
(An Oracle 604 Protect collected 29 April 2016)
Volatile Organics
Quandtation
MW-10
MW-14
EPA Method 8260 B
Limit
Parameter
(oub)
loob)
bpbj
Acetone
5.0
BQL
BQL
Aaolem
100
BQL
BQL
Aaylonitrile
lo0
BQL
BQL
Benzene
0.5
BQL
BQL
Bromobenzene
0.5
BQL
BQL
Brnmoahloromethaae
0.5
BQL
BQL
Bromodichlormnedume
0.5
BQL
BQL
Bromoform
l o
BQL
BQL
Bromomethane
1.0
BQL
BQL
2-Butanone
5.0
BQL
BQL
Carbon Disulfide
5.0
BQL
BQL
Cmban Tetrachloride
0.5
HQL
BQL
Chlorobemzene
0.5
BQL
BQL
Chloroedrane
1.0
BQL
BQL
2-Chloroethyl vinyl ether
5.0
BQL
BQL
Chloroform
0.5
BQL
BQL
Chlmnmethane
1.0
BQL
BQL
2-Chloromluene
05
BQL
BQL
4-ChloroWume
0.5
BQL
BQL
Cis-1,2-Dichloroethme
0.5
BQL
BQL
Cis-1,3-Dichloropropene
0.5
BQL
BQL
1,2-Dibr mo-3-Chloropropane(DBCP)
5.0
BQL
BQL
1,2-Dibromoetbane (EDB)
0.5
BQL
BQL
Dibromodrloramethe=
0.5
BQL
BQL
Dibromomethane
0.5
BQL
BQL
1,2-Dichlorobenzene
0.5
BQL
BQL
1,3-Dirhlombmzme
0.5
BQL
BQL
1,4-Didrlorobarzene
0.5
BQL
BQL
I ,1-Dichloroethanc
0.5
BQL
BQL
1,2-Dichloroerhane
0.5
BQL
BQL
1,1-Mchloroetheae
0.5
BQL
BQL
Dichloroflouromethane
0.5
BQL
BQL
1,2-Dichloropropene
0.5
BQL
BQL
1,3-Dichloropropane
0.5
BQL
BQL
2,2-Dichloropropanc
05
BQL
BQL
1,1-Diddoropropene
as
BQL
BQL
Ethyl Benzene
0.5
BQL
BQL
Hexarhlorobutadiene
05
BQL
BQL
2-Hexanone
so
BQL
BQL
WE
0.5
BQL
BQL
I-Propylbeazene
0.5
BQL
BQL
4-Methyl-2-Pemamone
5.0
BQL
BQL
Methyl lodide
1.0
BQL
BQL
Methylene Chloride
5.0
BQL
BQL
MTBE
0.5
BQL
BQL
Naphthalene
0.5
BQL
BQL
N-Butyfbemene
0.5
BQL
BQL
N-Propylbenzene
0.5
BQL
BQL
p-lsopropyttoluene
0.5
BQL
BQL
Sec-Butylbenzme
0.5
BQL
BQL
Styrene
0.5
BQL
BQL
Tat-Butylbenzase
0.5
BQL
BQL
1,1.1,2-Tetrachlmoethanc
0.5
BQL
BQL
1,1,2,2-Tetrachloroethane
0.5
BQL
BQL
Tetradtleroetbece
0.5
BQL
BQL
Toluene
0.5
BQL
BQL
Trani-1,2-Dichloroethene
0.5
BQL
BQL
Trans- l,3-Dichlorapropene
0.5
BQL
BQL
Trans- l,4-Dichlmro-2-buterre
5.0
BQL
BQL
1,2,3-Trichloroberume
0.5
BQL
BQL
1,2,4-Triehlorobmzene
0.5
BQL
BQL
1, 1,1-Triehlaroethane
0.5
BQL
BQL
1.1,2-Triehloroetheme
0.5
BQL
BQL
Trichloroethmc
0.5
BQL
BQL
Tridiloroflueromethane
0.5
BQL
6.0
1,2,3-Trichloroprapaae
0.5
BQL
BQL
1,2,4-Trimethylbemene
0.5
BQL
BQL
1,3,5-Truncthylberrzenc
0.5
BQL
BQL
Vinyl Acetate
Lo
BQL
BQL
Vmyl Chloride
0.5
BQL
BQL
Total Xylenes
1.0
BQL
BQL
lsopropanol
100
BQL
BQL
Isopropyl Acetate
1.0
BQL
BQL
Dilution Factor
I
r
Sample Number
19333-01 19333-02
Sample Date
0429/16 04/29/16
Sample Time (brs)
r
1210 1240
BQL - Below Quantitation Limits
Quantitsuon Haim must be multiplied by dilution factor
s s A!ucr,
O AN►Y�
ppb - parts per bMwn (ppb)

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
April 29, 2016
Weather Cloudy 69oF Date
Monitoring Well No..
MW-10
MW-14
Total Depth (Fr.)
30.12
30.14
Surface Depth (Fr.)
21.20
21.44
Water Depth (Fr.)
8.92
8.70
Diameter (IN.)
2"
2"
Conversion Factor
0.16
0.16
Well Volume (GAL)
1.43
1.39
Volume (GAL) X 3
4.28
4.18
ig Baits
18
17
Purge Date
0429/16
04/29/16
urge Time (hrs.)
1159
1216
Purge Method
Bailer
Bailer
Volume Removed (GAL)
3.75-Dry
3.25-Dry
Sampling Date
0429/16
0429/16
Sampling Time (bra.)
1210
1240
Sampling Method
Bailer
Bailer
pH (Standard Units)
6.51
6.42
Temperature (EC)
16.0
15.9
Conductivity (pmbos/cm)
99.7
110
bservatiomtSam lin
Clear
Clear

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
Water
/ Wastewater
Misc.
Company Oracle 604
Job No.
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Street Address
Project Groundwater
City, State, Zip
Sampler Name lease P/�' t)
Contact
Phone
Sampler Signature
a
o
Sample Number
(Lab Use Only)
Date
Time
Comp
Crab
Temp
"C
Res.
Cl,
Chlorine
Removed
Y or N
Sample
Matrix
(S or W)
Sample Location / I.D.
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Re ed By
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Sample Temperature at receipt C�-C

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
+
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Cleatfy or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 27105
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
ElSamples
for metals were collected unfiltered: OYES
❑ NO and field acidified: El YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/1
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(NoteUse MPN method for highly turbid samples)
Orthophosphate
mg/l
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
AI - Aluminum
mg/I
'
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
7
Chloride mg/1
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/G; "H
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen. Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
-IM617
MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 10/31/2016
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.47 units Temp. 16.9 °C
DRY at
Depth to Water Level: 12.22 ft. below measuring point
Screened Interval: 18.9 ft.
to
ft. Spec. Cond. µMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
check
Volume of water pumped/bailed before sampling:
33.0 gallons
Appearance Clear
here: ❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 10/31/2016
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/l
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(NoteUse MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone <5.0 (All in parts per billion)
pH (when analyzed) units
Ba - Barium
mg/I
Isopropanol <100
TOC mg/I
Ca - Calcium
mg/I
MEK <5.0
Chloride mg/I
Cd - Cadmium
mg/I
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/l
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, N1­13as N; Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/1
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev, 1/2007

SUBMIT FORM ON YFI I nW PAPFR nNl Y
GROUNDWATER QUALITY MONITORING:
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
r
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Pnnt Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note. Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/►
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit # W00006992
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. C 11/30/2016) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
Submittal of monitoring results for the Duke Power Well were delayed two (2) days beyond the due date for a
combination of reasons related to the date of receipt of the results and end -of -November holidays and
business -related travel.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional ice for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (G W-59A) of the monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current G W-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
,014pp""e� 12 -2-1 �
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
t ; W-591 12/8/2003

RESEARCh & ANAlyTICAI
LABORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
An Oracle 604 Protect collected 31 October 2016)
Volatile Organics
Quantitation
Duke Power Well
EPA Method 8260 B
Limit
Parameter
(ppbl
(ppb)
Acetone
5.0
BQL
Acrolem
100
BQL
Acrylonitrile
100
BQL
Benzene
0.5
BQL
Bromobenzene
0.5
BQL
Bromochloromethane
0.5
BQL
Bromodichloromethane
0.5
BQL
Bromoform
1.0
BQL
Bromomethane
1.0
BQL
2-Butanone
5.0
BQL
Carbon Disulfide
5.0
BQL
Carbon Tetrachloride
0 5
BQL
Chlorobenzene
0.5
BQL
Chlorcethane
LO
BQL
2-Chloroethyl vinyl ether
5.0
BQL
Chloroform
0.5
0
Chloromethane
1.
.67
BQL
Z•Chlorotaluene
.5
05
BQL
4-Chlorotolume
0.5
BQL
Cis-1,2-Dichloroethene
0.5
BQL
Cis-1,3-Dichloropropene
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5.0
BQL
1,2-Dibromoethme (EDB)
0.5
BQL
Dibromochloromethane
0.5
BQL
Dibromomethane
0.5
BQL
1,2-Dichlorobenzene
0 5
BQL
1,3-Dichlorobenzene
0.5
BQL
1,4-Dichlorobenzene
05
BQL
1, I-Dichloroethane
0.5
BQL
1,2-Dichloroethane
0.5
BQL
1,1-Dichlormthene
0.5
BQL
Dichloroflouromethane
0.5
BQL
1,2-Dichloropropene
0.5
BQL
1,3-Dichloropropene
0.5
BQL
2,2-Dichloropropene
0.5
BQL
1, I-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hexachlorobutadime
0.5
BQL
2-Hexanone
5o
BQL
IPE
0.5
BQL
1-Propylbenzene
0.5
BQL
4-Methyl-2-Pentanone
5.0
BQL
Methyl Iodide
1 0
BQL
Methylene Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzme
0.5
BQL
N-Propylbcnzenc
0.5
BQL
p-Isopropyltoluene
0.5
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
Tcrt-Butylbenzene
0.5
BQL
1, I, 1,2-Tetrachloroethane
0.5
BQL
1, 1,2,2-Tetrachloroethane
0.5
BQL
Tetrachloroethene
0.5
5.80
Toluene
05
BQL
Trans-1,2-Dichlaroethene
0.5
BQL
Trans-1,3-Dichloropropene
0.5
BQL
Trans-1,4-Dichlora-2-butane
5.0
BQL
1,2,3-Tnchlorobemme
0.5
BQL
1,2,4-Trichlorobemene
0.5
BQL
1, 1,1-Trichioroethane
0.5
BQL
1,1,2-Trichlormthane
0.5
BQL
Trichloroethene
0.5
BQL
Trichlorofluoromethane
0.5
1.60
1,2,3-Trichloroprmpane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-Trimethylbemme
0.5
BQL
Vinyl Acetate
1 0
BQL
Vinyl Chloride
0.5
BQL
Total Xylenes
1.0
BQL
lsopropanol
100
BQL
Isopropyl Acetate
1.0
BQL
Dilution Factor
I
Sample Number
26599-01
Sample Date
10/31/16
Sample Time (brs)
0740
BQL - Below Quanlitation Limits Qumtitation limits must be multiplied by dilution factor ppb - parts per billion (ppb)

<V ,
Research & Analytical
1
Laboratories, Inc.
i
4•
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODYRLCORD
Water /Wastewater
Company Oracle 604
Job No.
U
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Street Address
Project Groundwater
City, State, Zip
-7-
Sampler Name Please Pri )
rl
Contact
Phone
Sampler Signature
Sample Number
(Lab Use Only)
Date
Time
Comp.
Grab
Temp
uC`
Res.
CI.
Chlorine
Removed
Sample
Matrix[S7-,1mple
Location / I.D.
ZlgS`($a—U
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Duke Power Well
4
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TB
2
Re inqui b d By
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Remarks:
, tin s
Date/Time
Received By
n Ice
Sample Temperature at receipt 3
Misc.
"C
cequestea Analyst
RJR / 8260, Cond
TB

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
—IM617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 1
❑ Water Source Heat Pump ❑ Other:
(from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 01/28/2016
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.46 units Temp. 14.1 °C
DRY at
Depth to Water Level: 10.93 ft. below measuring point
Screened Interval: 18.9 ft. to 28.9
ft. Spec. Cond. µMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation: ft.
Odor
check
Volume of water pumped/bailed before sampling:
35.5 gallons
Appearance Clear
here: ❑
Samples for metals were collected unfiltered: EYES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 01/28/2016
Laboratory Name: Research & Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NOZ) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO eC I1 /C E,
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Tot a 1"' -
p
mg/I
(Note: Use MPN method for highly turbid samples)
Ortho hoS ha�E6 2 5 ?016
m / I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone 130 (All in parts per billion)
pH (when analyzed) units
Ba - BariumDWR SECTION
mg/1
Isopropanol <100
TOC mg/I
Ca ''^ FEIArilrfi ION PROCESS
Mg/l
MEK <5.0
Chloride mg/I
Cd - Cadmium
mg/I
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORMIM-16117
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address. 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from
Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
El
Samples for metals were collected unfiltered: DYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; NH,as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Apent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; NH3as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
v/ V
Siqnature of Permittee (or
Agent)
_Z 3-
(Date)
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit # WQ0006992
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. (_ 02/29/2016) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional ice for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO" contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
Signature of Permittee (o Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(AV-59 k 12/8/2003

RESE.ARCh & ANA1YTICAL
LAbORATOR1ESt INC.
/analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Duke Power Well
(An Oracle 604 Pro eel collected 28 January 2016)
Volatile OreHnics Quantitation Duke Power Well
EPA Method 8260 B Limit
Parameter fnob) fnnb)
Acetone
50
130
Aaolem
100
BQL
Acrylonttrile
100
BQL
Betuene
05
BQL
Bromobenzene
05
BQL
Bromochloromethane
05
BQL
Bromodichloromethane
05
2.98
Bromoform
10
BQL
Bromomethane
1 0
BQL
2-Butanone
so
BQL
Carbon Disulfide
50
BQL
Carbon Tetrachloride
05
BQL
Chlorobenzene
05
BQL
Chloroethane
1 0
BQL
2-Chloroethyl vinyl ether
5.0
BQL
Chloroform
05
23.7
Chloromethane
10
BQL
2-Chlorotoluenc
05
BQL
4-Chlorotoluene
0.5
BQL
Cis-1,2-Dtchloroethene
0.5
BQL
05-1,3-Dichloropropene
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5.0
BQL
1,2-Dtbromoethane (EDB)
0.5
BQL
Dtbromochloromethane
0-5
BQL
Dtbromomethane
0.5
BQL
1,2-Dichlorobenzene
0.5
BQL
1,3-Dichlorobenzene
0.5
BQL
1,4-Dichlorobenzene
0.5
BQL
1,1-Dichloroethane
0.5
BQL
1.2-Diehloroethane
0.5
BQL
1,1-0ichloroethene
0.5
BQL
Dtchloroflouromethane,
0.5
BQL
1,2-Dtchloropropane
05
BQL
1,3-Dtchloropropane
0.5
BQL
2,2-Dtchloropropane
0.5
BQL
I ,1-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
liexachlorobutadtene
0.5
BQL
2-Hexanone
So
BQL
IPE
05
BQL
I-Propylbenzene
0.5
BQL
4-Methyl-2-Pentanone
50
BQL
Methyl Iodide
10
BQL
Mcthy1mc Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzcnc
0.5
BQL
N-Propylberuene
05
BQL
p-Isopropyltoluene
05
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
Ten-Butylbenzene
05
BQL
1,1.1 2-Tetrachloroethane
0.5
BQL
1,1,2,2-Tetrachloroethane
05
BQL
Tetrachloroethene
0.5
BQL
'Toluene
0.5
BQL
Trans-1,2-Dichleroethene
0.5
BQL
Trans-1,3-Dtchloropropene
0.5
BQL
Tram-1,4-Dichloro-2-butene
5.0
BQL
1,2,3-Tnchlorobenzene
0.5
BQL
1,2,4-Tnchlorcbenzene
0.5
BQL
1, 1. 1 -Trichloroethanc
0.5
BQL
1,1,2-Triehloroethane
0.5
BQL
'fnchloroethene
05
BQL
Tnchlorofluoromethane
05
BQL
1,2,3-7nchloropropane
0.5
BQL
1,2,4-Tnmethylbenzene
0.5
BQL
1,3,5-Tranethylbenzrne
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
'Total Xylem
10
BQL
Isopropanal
100
BQL
Isopropyl Acetate
1 0
BQL
Dilution Factcr
I
Sample Number
14424-01
Sample Date
01/28/16
Sample'fime (hrs)
1553
c
ga ......
BQL - Below Quanutauon Lumts ppb = parts per billion (ppb) J - Estimated concentration. present but below quanutaticn limn

GROUNDWATER MONITORING FIELD LOG
Facility Oracle Plant 604
January 28, 2016
Weather P. Cloudy - 440F Date
Personnel Present: COMMENTS:
Glenn Price
-..........
-...... —

Research & Analytical
Laboratories, Inc.
AnalNtical / Process Consultations
Phunc [phone]
CHAIN OF CUSTODY RECORD
ICuter/
bti/ave;vater
Alisc.
Cumpan) Oracle 604
Job No.
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—
Strcct Address
Project Groundwater —
City, State, zip
Sampler Name /(/P"�/1{eyr/s --I rint)(
Contact
Phunc
Sampler Sionature
Lab Ise (h,h)
LI, 'L:%�
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Sample Location,, I.D.
O
Rcc ucsted Anah,sis
Duke I'urcer Well
4
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RJR / 8260, Cund
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RESEARCh & ANALyTICAt
LAbORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Duke Power Well
(An Oracle 604 Pro&ct, collected 28 January 2016)
Volatile Orl4anies Quantitation Duke Power Well
EPA Method 8260 B Limit
Parameter (opbl (pph)
Acetone
5.0
130
Acrolein
100
BQL
Acrylonitrile
100
BQL
Benzene
0.5
BQL
Bromobenzene
0.5
BQL
Bromochlaromethane
0.5
BQL
Bromodichloromethane
0.5
2,98
Bmmoform
1.0
BQL
Bromomethane
1.0
BQL
2-Butanone
5.0
BQL
Carbon Disulfide
5.0
BQL
Carbon Tetrachloride
0.5
BQL
Chlorobenzene
0.5
BQL
Chlorocthane
I.0
BQL
2-Chloroethyl vinyl ether
5.0
BQL
Chloroform
0.5
23.7
Chloromethanc
1.0
BQL
2-Chlorotoluene
0.5
BQL
4-Chlorotoluene
0.5
BQL
Gs-1,2-Dichlorocthene
0.5
BQL
Cis-1,3-Dichloropropenc
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5.0
BQL
1,2-Dibromoethane (EDB)
0.5
BQL
Dibromochloromethane
0.5
BQL
Dibromomethanc
0.5
BQL
1,2-Dichlorobemene
0.5
BQL
1,3-Dichlorobenzene
0,5
BQL
1,4-Dichlorobenzene
0.5
BQL
1,1-Dichlorocthane
0.5
BQL
1,2-D ichlorocthane
05
BQL
I ,1-Dichloraethene
0.5
BQL
Dichloroflouromethane
0.5
BQL
1,2-Dichloropropane
0 5
BQL
1,3-Dichloropropane
0.5
BQL
2.2-Dichlorapropane
0.5
BQL
1, I-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hcxachlorobutadiene
0.5
BQL
2-Hexanone
5.0
BQL
IPE
0.5
BQL
1-Propylbenzenc
0.5
BQL
4-Methyl-2-Pentanone
5.0
BQL
Methyl Iodide
1 0
BQL
Methylene Chloride
5.0
BQL
M'rBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzene
0.5
BQL
N-Propylbenzene
0.5
BQL
p-Isapropyltoluenc
0.5
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
'Icrt-Butylbenzene
0.5
BQL
1, 1. 12-Tetrachloroethanc
0.5
BQL
I, 1,2,2= retraehloroethane
0.5
BQL
'retrachloroethene
0.5
BQL
Toluene
0.5
BQL
Trani-1,2-Dichloroethene
0.5
BQL
Trams-1,3-Dichloropropenc
0.5
BQL
Trans- l,4-D ichloro-2-butcne
5.0
BQL
1,2,3-Trichlorobenzenc
0.5
BQL
1,2,4-Trichlorobenzenc
0.5
BQL
1,1,1-Trichloraethane
0.5
BQL
1,1,2-Trichlorocthanc
0.5
BQL
Trichloroethene
0.5
BQL
I richlorofluaromethane
05
BQL
1,2,3-Trichlorepropane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-'rrimethylbenzene
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
'total Xylenes
1.0
BQL
Isopropanol
100
BQL
Isopropyl Acetate
1 0
BQL
Dilution Factor
I
Sample Number
14424-01
Sample Date
01/28/16
Sample Time (hrs)
1553
Nb Ml�[Yri
or.
NC M34 zj�I=
BQL - Below Quantrtation Limits ppb -parts per billion (ppb) 1 - Estimated concentration, present but below quantitation limit

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
January 28,2016
Weather P. Cloudy - 44°F Date
Monitoring Well N06.
Water Depth (FT.)

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
Writer
/
Wasteivater
Mice.
Company Oracle 604
Job No.
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Street Address
Project Groundwater
City, State, Zip
Simpler Name (p*1 so Print)
Contact
Phone
Sampler Signature
Sumple Number
(I,ab Use Only)
Date
Time
Comp.Grab
'temp
ot,
Res.
(l
Chlorine
Removed
V or N
Sample
14atris
S or W
Sample Location / I.D.
O
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Requested Anal sis
>
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Duke Power Nell
4
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RJR / 8260, Cond
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Relit luisl e41 By
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Remarks:
ell' ui ec ;
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On Ice
Sample Temperature at receipt a °C

GW-59A COMPLIANCE REPORT FORM Permit # WQ0006992
(.Submit one each monitoring period with GW-59 forms.)
j
Enter date monitoring results were due. (-11/30/2015) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is `YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing_
YES
NO
identification plate, area overgrown, etc.)? if the answer is "Yes ", contact the Regional ice for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
X
If the answer to question 4 is `NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wellsfilgvi&6�11y mar t�tzonstituent(s) and concentration(s)
exceeding standards in the space provided below: .2. o uvv,
j O
W
oz
LL C
LLJ
5
For the constituents identified in question 4 above, have s#an ds befit exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years? `r
LL
z
If the answer to question 5 is `NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO'; contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
Fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
11- Z
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(INV-59% 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
JIDEPARTMENT
OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Wonston-Salem NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
(from
Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 10/29/2015
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.14 units Temp. 17.3 °C
DRY at
Depth to Water Level: 12.24 ft. below measuring point
Screened Interval: 18.9 ft.
to 8.9
ft. Spec. Cond. µMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
check
Volume of water pumped/bailed before sampling:
33.0 gallons
Appearance Slightly Turbid
here: ❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 10/29/2015
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/1
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone <5.0 (All In parts per billion)
pH (when analyzed) units
Ba - Barium
mg/I
Isopropanol <100
TOC mg/I
Ca - Calcium
mg/I
MEK <5.0
Chloride mg/I
Cd - Cadmium
mg/I
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N: Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
(VISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
��R'6117
MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the qroundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: DYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/1
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; NH3as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Hermlttee (or Autnorizea Agent) Name and I Itle - Please print or type
Signature of Permittee (or Authorized Agent)
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Wonstion-Salem NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
PH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at
the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: EYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

RESEARCh all ANAtyTICA1
LAbORATORIES, INC.
Ar,alyllccd/Process ConsultOtlonS
Chemical Analysis for Sdected Parameters and Sampling Location 1dend ied as Duke Power WcU
(An Oracle 604 Proied collected 29 October 201 SV
L Volattle Organics
Quandtation
Duke Power Well
EPA Method SM B
Limit
Parameter
IRRM
IRRW
Aaonne
5.0
BQL
Aaalem
100
BQL
Aaylmiuilc
100
BQL
Bcn=w
0,5
BQL
Brmobmxene
0.5
BQL
Brmorbla®eclune
0.5
BQL
Bromodiehlmmethme
0.5
BQL
Brmoform
1.0
BQL
Bromor>�e
1.0
BQL
2-Bunoouc
5.0
BQL
Cwbcu Div t
5.0
BQL
Carbva Tetrachloride
0.5
BQL
Chlorobeassue
0.5
BQL
Chlaroedme
1.0
BQL
2-Chloroethyl vinyl cdm
5.0
BQL
Chloroform
0.5
BQL
Chlormed me
1.0
BQL
243blmosoh me
0.5
BQL
4-ChIcrou*ume
0.5
BQL
Ci3-1,2-Dirbloroaheae
0.5
BQL
Cis-1,3-Diehlorquapme
0.5
BQL
I,2-Ddrrmo-3-ChWropropanc(DBCP)
5.0
BQL
1,2-Daromaet me (EDB)
0.5
BQL
Dibromothlor®ethma
0.5
BQL
Drbrmamcftme
0.5
BQL
1,2-Dichlarobeoxme
0.5
BQL
1,3-I)mblorobau me
0.5
BQL
1,4-Diehlorobmxne
0.5
BQL
l,l-Dith►maed me
0.5
BQL
1,2-13iddmoed me
0.5
BQL
l,l-Diehlmoedm=
0.5
BQL
Diehlorolbrumeti me
0.5
BQL
1,2-Diropme
0.5
BQL
1,3-Diehlmaprop-
0.5
BQL
2j-Dichloropropene
0.5
BQL
1,1-Oublo opropene
0.5
BQL
Ethyl Beacene
0.5
BQL
Hexachlmnbtandienc
0.5
BQL
2-Hesarmae
5.0
BQL
IPE
03
BQL
I-Propy}bmttm
0.5
BQL
4-Me1by1-2-Pmtm®e
5.0
BQL
Methyl Iodide
1.0
BQL
Methylene Chloride
5.0
BQL
MTHE
0.5
BQL
Naphthalene
03
BQL
N-Bu* beosme
0.5
BQL
N-1horAbtmsme
0.5
BQL
p-1sq- yi a
0.5
BQL
SeoBurymemcne
0.5
BQL
Styrene
0.5
BQL
Tert-Butylbmsene
0.5
BQL
1,1,1,24maehloroethme
0.5
BQL
1,1,2,2-Teuaahlmoelhaoe
0.5
BQL
TemachloroetbeDc
0.5
BQL
Tcluenc
0.5
BQL
Tram-1,2-Diehlmocdww
0.5
BQL
Tram-1 3 Didtbrapropem
0.5
BQL
Tans-1,44Dithloro2-butene
50
BQL
1,2,3-TricbaObcn=c
0.5
BQL
I A4-Tn& mobmsme
0.5
BQL
I,1,1-Trichbmedum
0.5
BQL
1,1,2-Trirh3moedw=
0.5
BQL
Trithloroethene
0.5
BQL
Tune
0.5
BQL
1,2,3-Tndda opropme
0.5
BQL
I A4-Try
05
BQL
1,3,54nmethylbeereue
0.5
BQL
Vial Acetate
1.0
BQL
Vinyl Cblmide
0.5
BQL
Tote! Xylem
1.0
BQL
tsapropand
100
BQL
[aopWA Mean
Dthrti® Factor
1.0
BQL
I
Sample Number
11018-01
Sample Date
1042W15
Semple Time (brs)
1653
BQL - Below /imitation Lmiim ppb - Nara per bi - (ppb) 1- Estimamd eoocmtrsrioa, present but below qummmuon limit

RESEARCh & ANAlyTICAt
L.AbORATORIES, INC.
For: Oracle Flexible Packaging
P.O. Box 11137
Winston-Salem, NC 27116
Attn: W. Scott Snow
Report of Analysis
11 /10/2015
�•
QC
Q ice NC #34 y�
NC #37701
Client Sample ID: Duke Power Well Lab Sample ID: 11018-01
Site: Oracle 200 Collection Date: 10/29/2015 16:53
IParameter Method Result Units Rep Umit Analyst Analysis DatelTime
Conductivity EPA 120.1 54.1 umhos/cm 10 SM 11/6/2015
NA = not analyzed
P.O. Box 473 106 Short Street KemersvUle, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page
ral coa basic Od

GROUNDWATER MONITORING FIELD LOG
Personnel Present:
Facility Oracle Plant 604 Glenn Price
October 29, 2015
Weather P. Cloudy - 72°F Date
COMMENTS:
... _......... -_.............. _.._... -_.__.........
......... _.......
_............ _......
._..............................
__...._......................
_._......._...._._._.
..........................................
_...................
........................ _...............................
........ . . ........
.. .... -------- -- ------------------
III
.

RESEARCh & ANA[yTICAI
LAbORATORIES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
I WATER I WASTEWATER 1 MISC. I
COMPANY
JOB N0.
=
o
a
ti �O� p�
¢D
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\¢o TV gyp. JcQ `W, 'r.�`aco
Q• \� �0}�O�' O' o° 00 �P
2 a O o U S C,
ryv a yo ho v v v .o
ry ry ry ^ REQUESTED ANALYSIS
STREET ADDRESS
PROJECT
CITY, STATE, ZIP
SAMPLER NAME (PLEASE PRINT)
CONTACT PHONE
SAMPLER SIGNATURE
SAMPLE NUMBER
(LAB USE ONLY)
DATE
TIME
COMP
GRAB
TEMP
eC
RES
r�1 !
RE'ORNZ
E o E-
iA! x
s T UX
SAMPLE LOCATION I I.D.
Z%1
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�Vl 17 v
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RELINQUISHED BY
DATE�v1E
RECEIVED BY
REMARKS:
SAMPLE TEMPERATURE AT RECEIPT 3' °C
RELINQUISHED BY
DATEITIIv is
V-f\
RECEIVED BY
u

SUBMIT FORM ON YELLOW PAPER ONLY
T
0 0 1
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
M7
,
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance T�1:1
Samples for metals were collected unfiltered: ❑YES
El NO and field acidified: ❑ YES
El NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N_
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(NoteUse MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
Rtt,rl
TOC mg/I
Ca - Calcium
mg/I
r n n
Chloride mg/I
Cd - Cadmium
mg/I
��_
Arsenic mg/I
Chromium: Total
mg/I
DwR SECTION
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by Gppgq I CESSI
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
, method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
10016117
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220_ Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 27105
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the qroundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /loom[
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /loom[
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
, method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
JillDEPARTMENT
OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
_Z9=617
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 07/31/2015
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.09 units Temp. 21.7 °C
DRY at
Depth to Water Level: 11.77 ft. below measuring point
Screened Interval: 18.9 ft.
to 28.9ft.
Spec. Cond. µMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
check
Volume of water pumped/bailed before sampling: 17.50 gallons
Appearance Clear
here: ❑
Samples for metals were collected unfiltered: EYES ❑ NO
and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 07/31/2015
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/l
Pb - Lead mg/l
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml Phosphorus: Total as P
mg/I
(Note. Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone <5.0 (All In parts per billion)
pH (when analyzed) units
Ba - Barium
mg/I
Isopropanol <100
TOC mg/I
Ca - Calcium
mg/I
MEK <5.0
Chloride mg/I
Cd - Cadmium
mg/1
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
mg/I
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/l
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; N1­13as N, Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
, method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit 4 W00006992
(Submit one each monitoring period with GW-59 forms.)
j
Enter date monitoring results were due. `08/30/2015) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES'; list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information-
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? ff the answer is "Yes", contact the Regional (ice for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is `NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days; an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation
Fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with G W-59 forms for required wells to the address provided at the top of the current G W-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
AV-59 k 12/8/2003

RESEARCh & ANA YTkAt
LAbORATORiES, INC.
ArKAYllcd/P►ocess Consultratlons
Chemical Analysis for Selected Parameters and Sampling Location IdeJrtt, fled as Doke Power WeU
An Orade 604 Prolerb co&cted 31 && 2015)
Volatik Organics
Qaantitation
Duke Power Well
EPA Method JI M0 B
limit
Paramete
(DIIb)
(npb)
Acemoe
5.0
BQL
Aadcm
I
BQL
Acrylowbile
100
BQL
Beozme
0.5
BQL
Bromobenzene
0.5
BQL
Bromodiommeftne
0.5
BQL
Bromodiehlorometha=
0.5
BQL
Bromofam)
1.0
BQL
Bromamobme
1.0
BQL
2-Bwame
5.0
BQL
Carbon Dwalfide
5.0
BQL
Carbon Tebachlande
0.5
BQL
(blambenaene
0.5
BQL
Chlmoetinac
1.0
BQL
2-Chlmoethyl vinyl ether
5.0
BQL
Chloroform
0.5
BQL
Chlmcmethme
1.0
BQL
2-(blorotohrene
0.5
BQL
443darototanc
0.5
BQL
Cis 12-Di�roefhme
0.5
BQL
Cis 1}-0lmoprop�
0.5
BQL
1,2-13Rromo313loropropaac(DBCP)
5.0
BQL
U-Dtbromotxlme (EDB)
0-5
BQL
Dtmtfhaae
0.5
BQL
Dtbromomethane
0.5
BQL
U-Dtchlarabcnn=
0.5
BQL
I,3-Dm*Icrobmt=e
0.5
BQL
1,4DuNofcbettzene
0.5
BQL
1,1-Diedlmoethane
0.5
BQL
1,2-Dwhbroethane
0.5
BQL
1,1-Ditbloraethene
0.5
BQL
Dkhlorotlourometharn
0.5
BQL
1.2-Dicitlaropopane
0.5
BQL
1,3-Dithlmopropane
0.5
BQL
2,2-Dichlaaprapane
0.5
BQL
l,l-Dicitlorapropcac
0.5
BQL
Ethyl Becttne
05
BQL
Hamclilardbutadme
0.5
BQL
2-Hexaatmc
5.0
BQL
IPE
0.5
BQL
I-Propymmzme
0.5
BQL
4-Mc**2-Pcm nonc
5.0
BQL
Methyl Iodide
1.0
BQL
Methylene Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzenc
0.5
BQL
N-Prgemz zeae
0.5
BQL
P-hq= WhoIU ne
05
BQL
Sec-Butyibmxme
0.5
BQL
Stytme
0.5
BQL
Tert-Bwylbmzme
0.5
BQL
1,1,1,2-Teoac6lmoetemc
0.5
BQL
1,1,2,2-Tevachloroethane
0.5
BQL
Tetrathlorcedrme
0.5
BQL
Tohrme
0.5
BQL
Trans-1,2-Dulloroethme
0.5
BQL
Tram-1,3-Dirhlmopropex
0.5
BQL
Tram-1,4-Duldoro2-borne
5.0
BQL
1,2,3-Trichlorob=zcnc
0.5
BQL
1,2,4-TrichIorcbmeme
0.5
BQL
I,1,1-Trichloroahane
0.5
BQL
1,1,2-Trithlmoed ane
0.5
BQL
TrKhlmocd=c
0.5
BQL
TrwWomflumomethane
0.5
BQL
IA3-Tn&kroluapeoe
0.5
BQL
IA4-Tnmethylbe»e
0.5
BQL
1 j,iTrimethytbmzme
0.5
BQL
Vinyl Arsaaae
1.0
BQL
Vinyl Chloride
05
BQL
Tool Xylem
1.0
BQL
Lwpropuld
100
BQL
Isopropyl Acetate
1.0
BQL
Dfluaan Factor
1
Sample Number
7541-01
Sample Date
07/31/15
Sample Time (bn)
1622
BQL - Below Qua dhat en L 93 ppb - parts per billion (ppb) J - F--d present but below clusomman limit

GROUNDWATER MONITORING FIELD LOG
]Facility Oracle Plant 604
July 31, 2015
Weather Partly Cloudy - 90OF Date
Personnel Present: COMMENTS:
Glenn Price
_....... _.._..._...._...... .............................
......
..... ........ _.... _......
_..... ._..............
__..._-........_.
......
-- -

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
PAn — r4Z(,l Qt1G_7R11
CHAIN OF CUSTODY RECORD
Water
/lVastewater
Misc.
Company (Oracle 60-1
Job No.
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City, State, Zip
Sampler Namc (Plea rint)112
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Contact
Phone
Sampler Signature
S:onphv Number
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Date
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Grnb
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Sample "l'emperature at receipt
°C

GW-59A COMPLIANCE REPORT FORM Permit # W00006992
(Submit one each monitoring period with G W-59forms.)
1
Enter date monitoring results were due. (_ 5/30/2015 ) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Officefor guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s)gnd concentration(s)
exceeding standards in the space provided below: N
0
z
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES" describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is havinq at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
fines, and/or penalties.
8
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
/7V AVr57-2 b-)
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
W -59 k 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
0 • •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
• • •
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Polo Road Complex No. of wells to be sampled: 0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent Date sample collected:
FIELD ANALYSES:
WAS
As per letter dated June 23, 2010, from Mr. David Yount of Oracle Flexible Packaging to Mr. Ted
Bush (Section Chief - Aquifer Protection Section, DWQ),
operation of the groundwater
remediation system under Permit WQ0006992 has been temporarily suspended.
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L Al -Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403 units Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC 00680 mg/L Ca - Calcium 00916
mg/L MEK <5.0 µg/L
Chloride 00940 mg/L Cd - Cadmium 01027
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic 01002 ug/L Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552 mg/L Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia 00610 mg/L Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) Mn - Manganese 01055
ug/L method #
TKN as N 00625 mg/L Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: — mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
W. Scott Snow - Environmental Engineer UZ , A/
Permittee (or Authorized Aqent) Name and Title - Please print or type Siqnature of Permittee
GW-59 Rev.8/2013
5-2 & —t s-
Aqent) (Date)

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
• •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
• • • •
1617 MAIL SERVICE CENTER, RALEIGH, INC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name Polo Road Complex No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent Date sample collected:
FIELD ANALYSES:
WAS
As per letter dated June 23, 2010, from Mr. David Yount of Oracle Flexible Packaging to Mr. Ted
Bush (Section Chief - Aquifer Protection Section,
DWQ), operation
of the groundwater
remediation system under Permit WQ0006992 has been temporarily suspended.
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615
mg/L Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L Al -Aluminum 01105
mg/L
pH (Lab) 00403 units Ba - Barium 01007
ug/L
TOC 00680 mg/L Ca - Calcium 00916
mg/L
Chloride 00940 mg/L Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos K - Potassium 00937
mg/L
method #
Total Ammonia 00610 mg/L Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
,method #
TKN as N 00625 mg/L Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.8/2013
of Permittee (or Authorized
(Date)

SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
, •
• DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon E Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 3
ElWater Source Heat Pump El Other
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-10
Date sample collected: 4/29/2015 FIELD ANALYSES:
WAS
Well Depth: 30.12 ft.
Well Diameter: 2.0 in.
pH 00400: 6.44 units Temp. 000lc 16.3 °C
DRY at
time of
Depth to Water Level 82546: 20.83 ft. below measuring point Screened Interval: 20.0 ft. to
30.0 ft. Spec. Cond. 00094: µMhos
—
sampling,
Measuring Point is 0.29 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling: 4.50
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/29/2015
Laboratory Name: Research & Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665
mg/L
(Note. Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum oilo5
mg/L Acetone <5.0 µg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC 00680 mg/L
Ca - Calcium oo916
mg/L MEK <5.0 µg/L
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L Isopropyl Acetate 0.0 µg/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00946 mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen, NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.8/2013
Signature of Permittee (or

Cl IanAIT Gnann nn1 VFI I r)IAI PAPFR OWI Y
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit)
If WELL
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): MW-14
Date sample collected: 4/29/2015 FIELD ANALYSES:
WAS
Well Depth: 30.14 ft.
Well Diameter: 2.0 in.
pH 00400: 6.44 units Temp. 000lc 6.44 °C
DRY at
time of
Depth to Water Level 82546: 21.33 ft. below measuring point Screened Interval: 20.0 ft. to
30.0 ft. Spec. Cond. 00094: µMhos
—
sampling,
Measuring Point is 0.75 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling: 4.25
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/29/2015
Laboratory Name: Research & Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum 01105
mg/L Acetone <5.0 µg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L Isopropanol <100 µg/L
TOC oosao mg/L
Ca -Calcium oosls
mg/L MEK <5.0 µg/L
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L Isopropyl Acetate <1.0 µg/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L Toluene <0.5 µg/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L VOC method # EPA 8260 B
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen, NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Ettluent I otai vUL;s: mg/L vw rwemvvallio
GW-59 Rev.8/2013

RI IRMIT FORM ON YELLOW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
DIVISION OF WATER RESOURCES - INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge WQ0006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ■ Remediation: Infiltration Gallery
Winston-Salem NC 27105 County Forsyth
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled: 3
❑ Water Source Heat Pump ❑ Other:
from Permit
If WELL
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 4/29/2015
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 00400: 6.63 units Temp. 000lc 16.9 °C
DRY at
me f
Depth to Water Level 82546: 10.47 ft. below measuring point
Screened Interval: 18.9 ft. to
28.9 ft.
Spec. Cond. 00094: µMhos
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: None
check
Volume of water pumped/bailed before sampling: 36.00
gallons
Appearance Clear
here:❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 4/29/2015
Laboratory Name: Research 8• Analytical Laboratories, Inc. Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31618 /100mL
Nitrate (NO3) as N 00620
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665
mg/L
(Note: use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum 01105
mg/L
Acetone <5.0 µg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
Isopropanol <100 µg/L
TOC 00580 mg/L
Ca - Calcium oo916
mg/L
MEK <5.0 µg/L
Chloride 00940 mg/L
Cd - Cadmium 01027
ug/L
Isopropyl Acetate <1.0 µg/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Toluene <0.5 µg/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 000m µMhos
K - Potassium 00937
mg/L
VOC method # EPA 8260 B
Total Ammonia oo810 mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen, NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug/L
method #
TKN as N 00625 mg/L
Ni - Nickel o1o67
ug/L
method #
0
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal /o
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or Noe
GW-59 Rev.8/2013
Signature

RESEARCh & ANAtyTICAt
LAbORATORIES, INC.
Analyhccl/Process Consultatlons
Chemical Analysis for Selected Parameters and Sampling Locations
(An Oracle 604 Bngg G collected 29 Aord 2015)
1, Volatile Organics
Quantitation
MW-10
MW-14
Duke
EPA Method 8260 B
Limit
Power
Parameter
(aDbl
(nobl
L22bl
(oabl
Acetone
5.0
BQL
BQL
BQL
Aerolem
100
BQL
BQL
BQL
Acrylonitrile
100
BQL
BQL
BQL
Benzene
0.5
BQL
BQL
BQL
Broambenzene
0.5
BQL
BQL
BQL
Bromachlommethane
05
BQL
BQL
BQL
Bromodichleramednee
05
BQL
BQL
BQL
Bromoform
10
BQL
BQL
BQL
Bromomethene
1.0
BQL
BQL
BQL
2-Butanoae
5.0
BQL
BQL
BQL
Carbon Disulfide,
5.0
BQL
BQL
BQL
Carbon Tetrachloride
0.5
BQL
BQL
BQL
Chlorobeozene
0.5
BQL
BQL
BQL
Chlwoethaae
1.0
BQL
BQL
BQL
2-Chlmnethyl vinyl ether
5.0
BQL
BQL
BQL
Chloroform
0.5
BQL
BQL
M
Chlaromethane
1.0
BQL
BQL
BQL
2-Chlorotolueae
0.5
BQL
BQL
BQL
4-Chlormoluene
05
BQL
BQL
BQL
Cis-1,2-Dirhlotoethene
05
BQL
BQL
BQL
Cis-1,3-Dchloropropme
0.5
BQL
BQL
BQL
1,2-Drbromo-3-C61mopropanc(DBCP)
5.0
BQL
BQL
BQL
1,2-Drbromoedrane(EDB)
0.5
BQL
BQL
BQL
Dbramorhlotamphsne
0.5
BQL
BQL
BQL
Dibrom=cd=e
0.5
BQL
BQL
BQL
1,2-Diehlorobenzene
0.5
BQL
BQL
BQL
1,3-0ichlorobewcot
0.5
BQL
BQL
BQL
1,4-Dichlorobcnzme
05
BQL
BQL
BQL
I,I-Dichloroethane
05
BQL
BQL
BQL
1,2-Didiloroedum
05
BQL
BQL
BQL
1,1-Di<hlornethcne
05
BQL
BQL
BQL
DiddoroBouromethane
0.5
BQL
BQL
BQL
1,2-Didrloropropane
0.5
BQL
BQL
BQL
1,3-Dichloropropane
0.5
BQL
BQL
BQL
2,2-Dichloropropane
0.5
BQL
BQL
BQL
1,1-Dichlaopropene
0.5
BQL
BQL
BQL
Ethyl Benzene
0.5
BQL
BQL
BQL
Heaadtlmobutat iene
05
BQL
BQL
BQL
2-Hexanonte
5.0
BQL
BQL
BQL
1PE
05
BQL
BQL
BQL
1-Propyibenzme
05
BQL
BQL
BQL
4-Methyl-2-Pemanoac
5.0
BQL
BQL
BQL
Methyl Iodide
10
BQL
BQL
BQL
Methylene Chloride
5.0
BQL
BQL
BQL
MTBE
0.5
BQL
BQL
BQL
Naphthalene
0.5
BQL
BQL
BQL
N-Butylbmaeae
0.5
BQL
BQL
BQL
N-Propyl enzene
0.5
BQL
BQL
BQL
p-Lwpmpyholume
0.5
BQL
BQL
BQL
Sec-Butylbeozeae
0.5
BQL
BQL
BQL
sty-
0 5
BQL
BQL
BQL
Tent-ButylemZme
0.5
BQL
BQL
BQL
1.1,1,2-Tetrachloroethana
0.5
BQL
BQL
BQL
1,1,2,2-Teasehlotaethana
0.5
BQL
BQL
BQL
Teaschloroed=c
0.5
0.8
0.6
6.4
Toluene
0.5
BQL
BQL
BQL
Tram.1,2-Didrloroethene
0 5
BQL
BQL
BQL
Tram.1,3-Dichlmopropeae
0.5
BQL
BQL
BQL
Tram-1,4-Dichlora2-butane
5.0
SQL
BQL
BQL
1,2,3-Trichlmobenzene
0.5
BQL
BQL
BQL
1,2,4-Trichlmobmrme
0.5
BQL
BQL
BQL
1,1,1-Tridrlaraethene
0.5
BQL
BQL
BQL
1,1,2-Triehloroed=c
0.5
BQL
BQL
BQL
Trichloroethene
0.5
BQL
BQL
BQL
Triehlorollucromethanre
0.5
BQL
19.0
0.6
1,2,3-Trichloropropam
0.5
BQL
BQL
BQL
1,2,4-Trimethylbenzene
0.5
BQL
BQL
BQL
1,3,5-Trimethylberzene
0.5
BQL
BQL
BQL
Vinyl Acetate
1.0
BQL
BQL
BQL
Vinyl Chloride
0.5
BQL
BQL
BQL
Total Xylenes
10
BQL
BQL
BQL
Isopropancl
100
BQL
BQL
BQL
L+opropyl Acetate
1.0
BQL
BQL
BQL
Dilution Factor
I
1
I
Sample Number
3599-03
3599-04
3599-01
Sample Date
0429115
04129/15
0429/15
Sample Time (hrs)
1029
1048
1155
' a
�nrusu�
BQL o Below Qum6tancn Lunits ppb - p- Per billion (DPb) J e Estimated cotncentration, proem but below gttantiztioa limo

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
April 29, 2015
Weather Clear 60°F Date
Monitoring Well No..
Duke Power
MW-10
MW-14
Total Depth (FT.)
28.91
30.12
30.14
Surface Depth (FT.)
10.47
20.83
21.33
Water Depth (FT.)
18.44
9.29
8.81
Diameter (IN.)
4"
2"
2"
Conversion Factor
0.65
0.16
0.16
Well Volume (GAL.)
11.99
1.48
1.41
Volume (GAL.) X 3
35.96
4.46
4.22
Bails L
144
18
17
Purge Date
04/29/15
04/29/15
04/29/15
Purge Time (hrs.)
1114
1028
1048
Purge Method
Bailer
Bailer
Bailer
Volume Removed (GAL.)
36.00
4.50
4.25
Sampling Date
04/29/15
04/29/15
04/29/15
autpling Time (hrs.)
1155
1044
1100
ampling Method
Bailer
Bailer
Bailer
pH (Standard Units)
6.63
6.44
6.44
t1hperature (EC)
16.9
16.3
16.7
011ductivity (Nmhos/cm)
250
97.7
60.1
RaervationASam lin
Clear
Clear
Clear

Research & Analytical
Laboratories, lnc.
AnalYtical / Process Consultations
Phone [phone]
CHAIN OF CUSTOD Y RECORD
fVater/
If'uste)vater
f O.
•�
1
MINC.
Company Oracle 604
Job No.
� _
� •1
„
Shret Address
Project i�J"rllf/Ill)Nlltel'
Cih' State Zip
I Sampler Name (P : Sc Print
Contact e Sampler Signature
Phon amp
Sample \umber
Date l inrr ('unt
(Lab Use (hrh) P
/ l l SS
temp Res. Chluriuc
Gtab „(• (t Kemot'crd Matrix
� �1'
Sample Location / LU.
Ihrl:c I'o��cr 11
ucsted Anahsis
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R.1R / 3260, Conti
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SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IM,617
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Wenston-S21em NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
1
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Duke Power Well
Date sample collected: 1/30/2015
FIELD ANALYSES:
WAS
Well Depth: 28.91 ft.
Well Diameter: 4.0 in.
pH 6.21 units Temp. 16.6 °C
DRY at
Depth to Water Level: 10.27 ft. below measuring point
Screened Interval: 18.9 ft.
to eft.
Spec. Cond. itMhos
time of
sampling,
Measuring Point is 0.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor
check
Volume of water pumped/bailed before sampling:
37.0 gallons
Appearance Clear
here: ❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 1/30/2015
Laboratory Name: Research
& Analytical
Labs Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /loom)
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /loom[
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
Acetone <5.0 (All in parts per billion)
pH (when analyzed) units
Ba - Barium
mg/I
Isopropanol <100
TOC mg/I
Ca - Calcium R EF C =- � , g.1D MEK <5.0
Chloride mg/I
Cd - Cadmium m /I
Isopropyl Acetate <1.0
Arsenic mg/I
Chromium: Total
,5
Toluene <0.5
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe -Iron .,-t,. ` -
mg{L,
; L„ (Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ® Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # EPA 8260 B
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N: Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
, method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
Signature of Permittee (or Authorized Aqent) ,`Date)
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
OF ENVIRONMENT& NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
MyEPARTMENT
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 220 Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Winston-SalemNC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Effluent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief - Aquifer
Protection Section, DWQ) operation at the groundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N. Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.1/2007

SUBMIT FORM ON YELLOW PAPER ONLY
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
617 MAIL SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31 /2016
Facility Name: Oracle Flexible Packaging - Polo Road Complex
Non -Discharge W00006992 UIC
Permit Name (if different):
NPDES Other
Facility Address: 2?n Polo Road
TYPE OF PERMITTED OPERATION BEING MONITORED
NC 271o5
County Forsyth
❑ Lagoon ® Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: W. Scott Snow
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Polo Road Complex
No. of wells to be sampled:
0
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): System Influent
Date sample collected:
FIELD ANALYSES:
WAS
Well Depth: ft.
Well Diameter: in.
pH units Temp. °C
DRY at
As per letter dated June 23, 2010 from Mr. David Yount (Oracle Flexible Packaging) to Mr. Ted Bush (Section Chief -Aquifer
Protection Section, DWQ) operation at the aroundwater remediation
system
under Permit WQ0006992 has been suspended.
Volume of water pumped/bailed before sampling:
gallons
Appearance
here:
❑
Samples for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NOZ) as N
mg/I
Pb - Lead mg/I
Coliform: MF Fecal /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
mg/I
(Note. Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total mg/I
Al - Aluminum
mg/I
pH (when analyzed) units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen, NH3as N, Ammonia Nitrogen, Total)
Mn -Manganese
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
W. Scott Snow - Environmental Engineer
Permittee (or Authorized Aqent) Name and Title - Please print or type
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit # W00006992
(Submit one each monitoring period with GW-59 forms.)
j
Enter date monitoring results were due. (_ 2/28/2015) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
X
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Office for guidance.
X
4
Are any monitored constituents equal to or above the established standards?
YES
NO
X
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
Signature of Permittee (or Authorized Agent) Date
W. Scott Snow - Environmental Engineer
(; V-59 k 12/8/2003

RESEARCIi & ANA1yTICA1
LABORATORIES, INC.
Analytical/Process Consultations
Chemical Analysis for Selected Parameters and Sampling Location Identified as Duke Power Well
An Oracle 604 Proiect, collected 30 January 2015)
1. Volatile Organics
Quantitatioo
Well
EPA Method 8260 B
Limit
Parameter
(Dpb)
Ippb)
Acetone
5.0
BQL
Acrolein
100
BQL
Acrylonitrile
100
BQL
Benzene
0.5
BQL
Bromobenzene
0.5
BQL
Bromochloromethane
0.5
BQL
Bromodichloromethane
0.5
BQL
Bromoform
1.0
BQL
Bromomethane
1.0
BQL
2-Butanone
5.0
BQL
Carbon Disulfide
5.0
BQL
Carbon Tetrachloride
0.5
BQL
Chlorobenzene
0.5
BQL
Chloroethane
1.0
BQL
2-Chloroethyl vinyl ether
5.0
BQL
Chloroform
0.5
BQL
Chloromethane
1.0
BQL
2-Chlorotoluene
0.5
BQL
4-Chlorotoluene
0.5
BQL
Cis-1,2-Dichloroethene
0.5
BQL
Cis-1,3-Dichloropropene
0.5
BQL
1,2-Dibromo-3-Chloropropane(DBCP)
5.0
BQL
1,2-Dibromoethane (EDB)
0.5
BQL
Dibromochloromethane
0.5
BQL
Dibromomethane
0.5
BQL
1,2-Dichlorobenzene
0.5
BQL
1,3-Dichlorobenzene
0.5
BQL
1,4-Dichlorobenzene
0.5
BQL
1,1-Dichloroethane
0.5
BQL
1,2-Dichloroethane
0.5
BQL
l,1-Dichlorcethene
0.5
BQL
Dichloroflouromethane
0.5
BQL
1,2-Dichloropropane
0.5
BQL
1,3-Dichloropropane
0.5
BQL
2,2-Dichloropropane
0.5
BQL
I,1-Dichloropropene
0.5
BQL
Ethyl Benzene
0.5
BQL
Hexachlorobutadiene
0.5
BQL
2-Hexanone
5.0
BQL
ME
0.5
BQL
I-Propylbenzene
0.5
BQL
4-Methyl-2-Pentanone
5.0
BQL
Metbyl Iodide
1.0
BQL
Methylene Chloride
5.0
BQL
MTBE
0.5
BQL
Naphthalene
0.5
BQL
N-Butylbenzene
0.5
BQL
N-Propylbenzene
0.5
BQL
p-Isopropyltoluene
0.5
BQL
Sec-Butylbenzene
0.5
BQL
Styrene
0.5
BQL
Tert-Butylbenzene
0.5
BQL
1, 1, 1,2-Tetrachloroethane
0.5
BQL
1,1,2,2-Tetrachloroethane
0.5
BQL
Tetrachloroethene
0.5
6.32
Toluene
0.5
BQL
Trans-1,2-Dichloroethene
0.5
BQL
Trans-1,3-Dichloropropene
0.5
BQL
Trans-1,4-Dichloro-2-butene
5.0
BQL
1,2,3-Trichlorobenzene
0.5
BQL
1,2,4-Trichlorobenzene
0.5
BQL
1, 1, 1 -Trichloroethane
0.5
BQL
1,1,2-Trichloroethane
0.5
BQL
Trichloroethene
0.5
BQL
Trichlorofluoromethane
0.5
0.76
1,2,3-Trichloropropane
0.5
BQL
1,2,4-Trimethylbenzene
0.5
BQL
1,3,5-Tiimethylbenzene
0.5
BQL
Vinyl Acetate
1.0
BQL
Vinyl Chloride
0.5
BQL
Total Xylenes
1.0
BQL
Isopropanol
100
BQL
Isopropyl Acetate
1.0
BQL
Dilution Factor
1
Sample Number
451-01
Sample Date
01/30/15
Sample Time (hrs)
1055
.J 1,4,,E v cyg4ty i
NO Mao z+
tea`•.
BQL = Below Quantitation Limits ppb = parts per billion (ppb) ] = Estimated concentration, present but below quantitation limit

GROUNDWATER MONITORING FIELD LOG
Personnel Present: COMMENTS:
Facility Oracle Plant 604 Glenn Price
January 30, 2015
Weather Partly Cloudy - 43°F Date
Monitoring Well No..
Duke Power
Well
Total Depth (FT.)
28.91
Surface Depth (FT.)
10.27
Water Depth (FT.)
18.64
Diameter (IN.)
4"
Conversion Factor
0.65
Well Volume (GAL.)
12.12
Volume (GAL.) X 3
36.35
Bails (L)
146
Purge Date
01/30/15
Purge Time (hrs.)
1001
Purge Method
Bailer
Volume Removed (GAL.)
37.00
Sampling Date
01/30/15
Sampling Time (hrs.)
1055
Sampling Method
Bailer
pit (Standard tJnits)
6.21
Temperature (EC)
16.6
Conductivity (µmhos/cm)
276
Observations\Sampiing
Clear

Research & Analytical
Laboratories, Inc.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD
Water / Wastewater
Misc.
Company Oracle 604
Job No.
a,
Q
C?
N
a
V
c
N
t
c
N
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a
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a
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CE
a
{x
a
Street Address
Project Groundwater
City, State, Zip
Sampler Name (Plc a Print
h`
v,
C
Contact
Phone
Sampler Signature
U
Sample Number
(Lab Use Only)
Date
Time
Comp
Grab
Temp
°C
Res.
CWorine
Removed
Y or N
Sample
Matrix
S or W
Sample Locafion / LD.
O
Requested Analysis
X
W
Duke Power Well
4
1
RJR / 8260, Cond
TB
2
TB
Reliinquishfd By
1 fi ate/Time
ire /z/0
eceived $y
is
Re rlcs:
�
Relinquished By
Date/Time
Rec 'ved By
i
On Ice
f
Sample "Temperature at receipt C