WI0400091_Injection Event Record_20191030

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources — Division of Water Resources
Permit Number ­ W1Q400091 A^
1. Permit Information
Gilbarco Veeder-Root
Permittee
Gilbarco Veeder-Root
Facility Name
7300 West Friendly Ave, Greensboro, NC
Facility Address
2. Injection Contractor Information
FnviroTrac Ltd
Injection Contractor / Company Name
Street Address 7343 West Friendly Ave
Greensboro NC 27410
City State Zip Code
L336.) 763-6025
Area code — Phone number
3. Well Information
Number of wells used for injection 16
Well names IW-1 through IW-16
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ bland -Augured ❑ Other (specifj,)
Please include a copy of the GIF4 form for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GYV-30 for each well
abandoned.
4. Injectant Information
Water
Injectant Type
Concentration
If the Injectant is diluted please indicate the source
dilution fluid.
Total Volume Injected 4,000 Gallons
Volume Injected per well 250 Gallons
5. Injection History
Injection date(s) 12/23/14 - 04/07/15
Injection number (e.g. 3 of 5) 1 of 1
Is this the last injection at this site?
® Yes ❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
SIG A'fURE OF IN.IEC'1 N CONTRACTOR DA E
PRINT NAME OF P1 RSO1 PERFORMING -ri lE INJECTION
Submit the original of this form to the Division of Water Resources within 30 days ofinjection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636. Phone No. 919-807-6464 Rev. 8/5/2013

wz0q-000,7
North Carolina Department of Environmental Quality — Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number W10400091
l . Permit Information
Gilbarco Veeder-Root
Permittee
Gilbarco Veeder-Root
Facility Name
7300 W. Friendly Ave, Greensboro, NC
Facility Address (include County)
2. Injection Contractor Information
EnviroTrac Ltd.
Injection Contractor / Company Name
Street Address 7343 W. Friendly Ave, Suite J
Greensboro NC 27410 R
City State Recki e
[phone] �EB 2 ?��$
Area code — Phone number
Water Quality
3. Well Information R,390111 Operations Secti
Number of wells used for injection 16
Well IDs IW-I through IW-16
Were any new wells installed during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Type of Well Installed (Check applicable type):
❑ Bored ❑ Drilled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please inclrrrle a copy of the GW-1 formfor each
well installed
Were any wells abandoned during this injection
event?
❑ Yes ® No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include a copy of the GW-30 for each well
abandoned,
4. Injectant Information
Hydrogen gas
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 1.6 to 1.9 pprn dissolved in water
If the injectant is diluted please indicate the source
dilution fluid. NA
Total Volume Injected (gal) Continuous passive gas
erection
Volume Injected per well (gal) NA
5. Injection History
Injection date(s) Continuous injection started
2/15/18
Injection number (e.g. 3 of 5) NA
Is this the last injection at this site?
❑ Yes ® No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
��;w
ID OUT IN THE PERMIT. p
2 /tp !U
NATURE OF 1ECT1O CONTRACTOR DATE
Cnt0EE&[]QRMING T1 I L ]NJ ECTION
W4;
Submit the original of this form to the Division of Water Resources within 30 days of injection. Form UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464 Rev. 3-1-2016

e y c�LsaRco
Ll1XVIS1O
NN OF WATER lRESCiJRCES
UP-CTOR'S OFF}Cr
r i kA- U October 17, 2019
Linda C pepper
Director, Division of Water Resources
NC DENR
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
RE: Underground Injection Permit WI0400091E
Dear Ms. Culpepper:
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: [phone]
www.gilbarco.com
This letter serves as official notification that I am replacing Robert Bondos at Gilbarco Inc.
located at 7300 West Friendly Avenue as signatory official in regards to this permit.
Jamey Greene, Vice -President of Operations, Americas
336-547-5000
* [e-mail]
If you require additional information please contact John Burke, Environmental Engineer, at
336-337-2746 or john.burke(}a�,gilbarco.com
Sincerely,
?Jame7yreene
Vice -President of Operations, Americas
Cc: Jordan Geras
John Burke
a 4w oua►ity
-wglonai flt ►8 SOO"

vo"j

North Carolina Department of Environment and Natural Resources
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation (I5A NCAC 02C .a2251 I Tracer Injection (15A NCAC 02C .0229)
Do not use this form for the following:
• in situ reinediation, tracer, or aquifer test injection wells permitted by rule (ref. 15A NCAC 02C .0217)
• remediation systems that reinject treated contaminated groundwater (ref15ANCAC 02T .16[000) j
Application Number (to be completed by DIFR): _ � V. Lf1C) I /
I. APPLICATION INFORMATION
1. Project is: [ ] New []Modification (�..Reueival wilhoirl modification [] Renewal ii,ilh modification
2. If Ibis application is being submitted for renewal or modification to an existing permit, provide:
existing permit mnnberykV1440009) and the issuance date 8/8/2012
For renewal without modifications, fill out sections I & 1/ only, sign the certification on the last page of this form, and obtain
the propeny owner's signature to indicate consent (rf the applicant is not the owner).
For all renewals, submit a staters report inchiding monitoring r•esulls of all injection activities to date.
H. WELL OWNER (generally the responsible party)
1. Name: Gilbarco
2. Signing Official's Name': Robert Bondos Title: Vice President US Operations
Signing Official must be in accordance with instructions in Part IX on page 5.
3. Mailing address of applicant: 7300 West Friendly Avenue
City: Greensboro State: NC Zip: 27410
4. Telephone number: [phone]
5. Status (choose one): Individual X Business/Org. Federal State —County —Municipality
RECEIVED/DENRIDWR
III. PROPERTY OWNER (if different than well owner)
1. Name: same
2. Physical address:
City:
3. Mailing address:_
City:
4. Telephone number:
APR 14 2015
Water Quality Regis
Operations 5ectR
State: Zip:
State: Zip:
I111. PROJECT CONTACT — Person who can answer technical questions about the proposed injection project.
1. Naine: Chris Hay Title. Principal
2. Company: EnviroTrac Ltd.
3. Address: 7343 West Friendly Avenue, Suite J
4. City: Greensboro State: NC Zip
27410
5. Telephone number: [phone] Email: [e-mail]
Revised 1 1/19/2013 UIC-51/5T Page 1 of 5

IX.
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Ini Sitir Groundwater Remediation ( Tracer Injection
CERTIFICATION* (to be signed as required below or by that person's authorized agent*)
NCAC 15A 02C .021 1(erequires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
*If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant
that names and authorizes their agent.
"I hereby cerli) under penally of lam, that I have personally examined and an► familiar with the in formation
submitted in this document and all attachments therein, and that, based on my inaluiny of those individuals
immediately responsible for obtaining said information, I believe that the h formation is true, accurate, and
complete. I am ainare that there are penalties, including the possibility offines and imprisonment, for submitting
false information. 1 agree to conshwct, operate, maintain, repair, and if applicable, abandon the injection well(s)
and all related appur/enances in accordance with the approved specificatibus and conditions of the Permit. "
Printed Name and
Signa
Bonds Vice President US O
Date:
X. CONSENT OF PROPERTY OWNER (if the property is not owned by the permit applicant)
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well is real
property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing.
"As owner of the properly on which the injection u,ell(s) are to be consh•ucted and operated, I hereby consent to
allow the applicant to consh•►ict each injection i►,ell as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the h jectiou )vell(s) conform to the If'ell Construction 8landarzls
(15A A'CAC 02C.0209). "
Printed Name and
Signature:
Submit TWO copies of the completed application package, including all attachments, to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 11/19/2013 UIC-51/5T Page 5 of

To:
_11
KL- EINFEL DER
bright People. Right Solutions.
TRANSMITTAL
Mr. Thomas Slusser
DWQ-Aquifer Protection Section
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Ms. Sarita Allen
Gilbarco
7300 West Friendly Avenue
Greensboro, North Carolina 27420-2087
Subject: Application to Construct and/or Use a Well for Injection
Gilbarco
7300 West Friendly Avenue
Greensboro, North Carolina
Date: 01-AUG-2012
Reference No: 97746 1 GSO12TO389
Copies to:
We are sending the following: ® Attached ❑ Under separate cover
♦ Two copies of the application - DWQ
♦ One copy of the application - Gilbarco
Via:
❑ Messenger/Courier
® First Class Mail
❑ FedEx
❑ United Parcel
❑ DHL
❑ Lone Star Overnight
❑ Freight
❑ Other
Transmitted:
❑ As Requested
❑ For Approval
❑ For Your Use
❑ For Review & Comment
By:
tnvsronmenta� Program Manager
313 Gallimore Dairy Road, Greensboro NC 27409 - P1 336.668.0093 - DI 336.668.0411 - F1 336.668,3868 ���D�ryrN�Df ■Q
RECE DE
AUG 45 Z02
Aquifer Protection Section

W
Zi

North Carolina ,partment of Environment an( itural Resources
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
Do not use this form for the following:
• in situ remediation, tracer, or aquifer test injection wells permitted by rule (ref. 15A NCAC 02C .0217)
• remediation systems that reinject treated contaminated groundwater (ref. 15A NCAC 02T .1600)
I.
II.
Application Number (to be completed by DWQ):
APPLICATION INFORMATION
1. Project is: [ ] New [x] Modification [ ] Renewal without modification [ ] Renewal with modification
2. If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number WI0400091 and the issuance date April 20, 2010
For renewal without modifications, fill out sections 1 & H only, sign the certification on the last page of this form, and obtain
the property owner's signature to indicate consent (f the applicant is not the owner).
For all renewals, submit a status report including monitoring results of all injection activities to date.
WELL OWNER (generally the responsible party)
1. Name: Gilbarco
2. Signing Official's Name*: Roy Walker Title: Vice President US Operations
* Signing Official must be in accordance with instructions in part VI on page 7.
3. Mailing address of applicant: 7300 West Friendly Avenue
City: Greensboro State: NC Zip: 27420-2087
4. Telephone number: 336.547.5130 Email:
5. Status (choose one): Individual X Business/Org. Federal State County Municipality
III. PROPERTY OWNER (if different than well owner)
1. Name:
2. Physical address:
City:_
3. Mailing
City:
4. Telephone number: Email:
State: Zip:
State: Zip:
IIII. PROJECT CONTACT — Person who can answer technical questions about the proposed injection project.
1. Name: Chris Hay Title: Environmental Program Mpr
2. Company: Kleinfelder Southeast, Inc.
3. Address: 313 Gallimore Dairy Road
4. City: Greensboro State: NC Zip: 27409
5. Telephone number: 336.668.0093 Ext. 113 Email: chayAkleinfelder.com
Revised 5/1/2012 U1C-51/5T RECEIVENENR M Pagel of 5
AUG 0 6 2012
Aquifer Protection Section

APPLICATION FOR P. [IT TO CONSTRUCT AND/OR USE ELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
V. FACILITY INFORMATION
1. Facility name: Gilbarco Ph#: 336.547.5130
2. Mailing address: Post Office Box 22087
City: Greensboro County: Guilford State:NC Zip: 27420-2087
3. Geographic Coordinates: Latitude: 36.0901 N Longitude: 79.9282 W
Reference Datum: Accuracy:
Method of Collection: County GIS
4. Brief description of business: manufacturer of fuel dispensers
VI. INCIDENT DESCRIPTION
1. Source and date of contamination: Release from a 1,000 gallon diesel UST and four 550 gallon gasoline
USTs was discovered in November and December 1994. The quantity released is unknown. The tanks were
removed from the site.
2. List all contaminants present in soils or groundwater at the site (contaminants may be listed in groups, e.g., gasoline,
diesel, jet fuel, fuel oil, chlorinated ethenes, chlorinated ethanes, metals, pesticides/herbicides, etc):
Gasoline, diesel, chlorinated ethenes, and chlorinated ethanes
3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection zone)?
[X] YesIf yes, list maximum measured separate phase thickness: 0.1 feet
[ ] No If no, list maximum concentration of total VOCs observed at site: ppb
4. Agency managing the contamination incident:
[ ] UST Section [ ] Superfund Section (including REC Program and DSCA sites)
[ ] DWQ Aquifer Protection Section [ ] Solid Waste Section
[ ] Hazardous Waste Section [X] Other: Guilford County Dept. of Env. Health
5. Incident manager's name: Gene Mao Ph#: 336.641.3771
6. Incident number or other incident mgmt. agency tracking number: 12960
VII. PERMITS
List all applicable permits or construction approvals issued for the facility or incident:
1. Hazardous Waste Management program permits under RCRA: LOG NCD001115245
2. DWQ Non -Discharge or NPDES permits: NPDES NCG030000
3. County or DEH subsurface wastewater disposal permits: City of Greensboro Industrial WW:S-2010
4. Other environmental permits required by state or federal law: Well Construction Permit No.042-96-MW 10-RW 1
Revised 5/1/2012 UIC-5I/5T Page 2 of 5

APPLICATION FOR P iIT TO CONSTRUCT AND/OR USE ELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
VIII. ATTACHMENTS — provide the following information in separate attachments. The attachments should be
clearly identified and presented in the order below to expedite review of the permit application package.
1. INJECTION ZONE — Specify the horizontal and vertical portion of the subsurface within which the proposed injection
activity will take place and beyond which no violations of groundwater quality standards shall result from the injection as
determined by an approved monitoring plan. The determination shall be based on the hydraulic properties of the specified
zone. Provide any supporting documentation in a separate attachment.
2. HYDROGEOLOGIC EVALUATION — Provide a hydrogeologic evaluation of the injection zone that includes all of
the following:
(A) Regional and local geology and hydrology;
(B) Changes in lithology underlying the facility;
(C) Depth to bedrock;
(D) Depth to the mean seasonal high water table;
(E) Hydraulic conductivity, transmissivity, and storativity, of the injection zone based on tests of site -specific
material, including a description of the test(s) used to determine these parameters;
(F) Rate and direction of groundwater flow as determined by predictive calculations or computer modeling; and
(G) Lithostratigraphic and hydrostratigraphic logs of any existing test and injection wells.
3. INJECTANT INFORMATION — List each injectant in the space below and provide the following information for each
injectant. NOTE: Approved injectants can be found online at httn:llportal.ncdenr.orglxlehhtglapLIDrpro. All other substances
must be reviewed by the Division of Public Health, Department of Health and Human Services. Contact the UIC Program for
more information (Ph# 919-807-6496).
Regenesis 3D Microemulsion (HRC Advanced) , municipal water from City f Greensboro
(A) MSDS, concentration at the point of injection, and percentage if present in a mixture with other injectants;
(B) The source of fluids used to dilute, carry, or otherwise distribute the injectant throughout the injection zone. If
any well within the area of review of the injection facility is to be used as the fluid source, then the following
information shall be submitted: location/ID number, depth of source, formation, rock/sediment type, and a
chemical analysis of the water from the source well, including analyses for all contaminants suspected or
historically recognized in soil or groundwater on the site;
(C) A description of the rationale for selecting the injectants and concentrations proposed for injection, including an
explanation or calculations of how the proposed injectant volumes and concentrations were determined;
(D) A description of the reactions between the injectants and the contaminants present including specific breakdown
products or intermediate compounds that may be formed by the injection;
(E) A summary of results if modeling or testing was performed to investigate the injectant's potential or susceptibility
for biological, chemical, or physical change in the subsurface; and
(F) An evaluation concerning the development of byproducts of the injection process, including increases in the
concentrations of naturally occurring substances. Such an evaluation shall include the identification of the specific
byproducts of the injection process, projected concentrations of byproducts, and areas of migration as determined
through modeling or other predictive calculations.
4. INJECTION PROCEDURE — Submit a table with a detailed description of the proposed injection procedure that
includes the following:
(A) The proposed average and maximum daily rate and quantity of injectant;
(B) The average maximum injection pressure expressed in units of pounds per square inch (psi); and
(C) The total or estimated total volume to be injected.
Revised 5/1/2012 UIC-51/5T Page 3 of 5

APPLICATION FOR P IIT TO CONSTRUCT AND/OR USE 'ELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
5. FRACTURING PLAN if applicable) NOT APPLICABLE— Submit a detailed description of the fracturing plan that
includes the following:
(A) Material Safety Data Sheets of fracturing media including information on any proppants used;
(B) a map of fracturing well locations relative to the known extent of groundwater contamination plus all buildings,
wells, septic systems, underground storage tanks, and underground utilities located within the Area of Review;
(C) a demonstration that buildings, wells, septic systems, underground storage tanks, and underground utilities will
not be adversely affected by the fracturing process;
(D) injection rate and volume;
(E) orientation of bedding planes, joints, and fracture sets of the fracture zone;
(F) performance monitoring plan for determining the fracture well radius of influence; and
(G) if conducted, the results of geophysical testing or pilot test of fracture behavior conducted in an uncontaminated
area of the site.
6. WELL CONSTRUCTION DETAILS — Submit the following information in tabular or schematic form as appropriate
for each item:
(A) number and depth of injection wells; 16 INJECTION WELLS TO 35 FEET (estimated depth of bedrock)
(B) number and depth of borings if using multi -level or "nested" well systems; NOT APPLICABLE
(C) indication whether the injection wells are existing or proposed; PROPOSED
(D) depth and type of casing; 2 INCH DIAMETER PVC FROM GROUND SURFACE TO 20 FEET
(E) depth and type of screen material; 2 INCH DIAMETER PVC FROM 20 TO 35 FEET
(F) depth and type of grout; NEAT CEMENT GROUT TO 16 FEET, BENTONITE FROM 16 TO 18 FEET
(G) indication whether the injection wells are permanent or temporary "direct push" points; and PERMANENT
(H) plans and specifications of the surface and subsurface construction details. SEE ATTACHED WELL
DIAGRAM
7. MONITORING PLAN — Submit a monitoring plan that includes the following:
(A) target contaminants plus secondary or intermediate contaminants that may result from the injection;
(B) other parameters that may serve to indicate the progress of the intended reactions;
(C) a list of existing and proposed monitoring wells to be used; and
(D) a sampling schedule to monitor the proposed injection.
Monitoring wells shall be of sufficient quantity and location to detect any movement of injection fluids, injection process byproducts,
or formation./luids outside the injection zone. The monitoring schedule shall be consistent with the proposed injection schedule, pace
of the anticipated reactions, and rate of transport of the injectants and contaminants.
8. WELL DATA TABULATION — Provide a tabulation of data on all existing or abandoned wells within the area of
review of the injection well(s) that penetrate the proposed injection zone, including monitoring wells and wells proposed
for use as injection wells. Such data shall include a description of each well's type, depth, and record of construction or
abandonment. SEE ATTACHED TABLE 1: MONITORING WELL CONSTRUCTION DATA
9. MAPS AND CROSS -SECTIONS — Provide scaled, site -specific site plans or maps depicting the location, orientation,
and relationship of facility components including the following:
(A) area map based on the most recent USGS 7.5' topographic map of the area, at a scale of 1:24,000 and showing the
location of the proposed injection site;
(B) topographic contour intervals showing all facility related structures, property boundaries, streams, springs, lakes,
ponds, and other surface drainage features;
(C) all existing or abandoned wells within the area of review of the wells listed in the well data tabulation that
penetrate the proposed injection zone;
(D) potentiometric surface map(s) that show the direction of groundwater movement, existing and proposed wells;
(E) contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the contaminant plume
in soil and groundwater, and existing and proposed wells;
(F) cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical extent of
the contaminant plume in soil and groundwater, major changes in lithology, and existing and proposed wells; and
(G) any existing sources of potential or known groundwater contamination, including waste storage, treatment, or
disposal systems within the area of review of the injection well or well system.
Revised 5/1/2012 UIC-5I/5T Page 4 of 5

IX.
X.
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
In Situ Groundwater Remediation I Tracer Injection
CERTIFICATION* (to be signed as required below or by that person's authorized agent*)
NCAC 15A 02C .0211(e) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
*If an authorized agent is signing on behalf of the applicant, then supply a letter signed by the applicant
that names and authorizes their agent.
"I hereby certify under penalty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that there are penalties, including the possibility offrnes and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well(s)
and all related appurtenances in accordance with the approved specifications and conditions of the Permit. "
Printed Name and Title:- Roy Walker Vice President US Operations
Signature.. ( Date: 1
CONSENT OF PROPERTY OWNER (if the property is not owned by the permit applicant)
"Owner" means any person who holds the fee or other property rights in the well being constructed A well is real
property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing.
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection-Avll(s) conform to the Well Construction Standards
(Title 1 SA NC AC 02C . 0200). "
Printed Name and
Signature: r Date: ( Z
Revised 5/1/2012
Submit TWO copies of the completed application package, including all attachments, to:
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVEDIDENRIDWQ
AUG b 6 2012
UIC-51/5T Page 5 of 5
Aquifer Protection section

TABLES

TABLE 1: MONITORING WELL CONSTRUCTION DATA
Well ID
Date Completed
Total Depth
(feet TOC)
Screened Interval
(feet TOC)
TOC Elevation
(feet)
Bottom Elevation
(feet)
Date Water
Level Checked
Static Water Level
(feet TOC)
Groundwater
Elevation (feet)
MW-7
3/17/1987
29.9
19.9-29.9
861.40
831.50
6/21/2012
6.15
855.04
MW-10
3/17/1987
33.6
23.6-33.6
859.25
825.65
6/21/2012
9.55
848.13
MW-11
9/22/1987
25.1
14.1-25.1
859.26
834.16
6/21/2012
14.90
844.36
MW-12
7/17/1987
16.8
11.8-16.8
851.50
834.70
6/21/2012
10.50
841.00
MW-12D
9/17/1987
27.0
24.0-27.0
851.06
824.06
6/21/2012
10.63
840.43
MW-13D
5/18/1988
39.4
34.4-39.4
860.40
821.00
6/21/2012
13.86
846.54
MW-14
5/17/1988
24.8
19.1-24.8
859.32
834.52
6/21/2012
22.15
837.17
MW-14D
5/17/1988
41.0
35.8-41.0
859.26
818.26
6/21/2012
22.94
836.32
MW-15
5/19/1988
25.2
15.2-25.2
857.71
832.51
6/21/2012
15.00
842.71
MW-16
6/14/1989
35.2
20.2-35.2
863.60
828.40
6/21/2012
29.21
834.39
MW-23D
6/22/1989
57.1
52.1-57.1
861.04
803.94
6/21/2012
16.81
844.09
MW-24
6/21/1989
58.8
53.8-58.8
858.81
800.01
6/21/2012
25.29
833.52
MW-25
3/22/1993
168.9
163.9-168.9
861.47
692.57
6/21/2012
24.18
837.29
MW-27
1/16/1995
44.0
39.0-44.0
862.74
818.74
6/21/2012
11.50
851.24
MW-28
1/16/1995
23.8
8.8-23.8
861.54
837.74
6/21/2012
6.79
854.75
MW-29
5/29/1995
18.8
3.8-18.8
861.18
842.38
6/21/2012
5.11
856.02
MW-30
5/30/1995
73.4
68.4-73.4
862.28
788.88
6/21/2012
11.97
850.31
MW-31
5/31/1995
19.0
4.0-19.0
861.73
842.73
6/21/2012
9.17
852.56
MW-32
6/1/1995
19.6
4.6-19.6
861.76
842.16
6/21/2012
7.73
854.03
MW-33
8/21/1995
21.0
6.0-21.0
861.77
840.77
6/21/2012
13.81
847.96
MW-34
8/21/1995
21.0
6.0-21.0
860.45
839.45
6/21/2012
6.96
853.49
MW-40
2/14/1996
29.7
4.7-29.7
860.62
830.92
6/21/2012
10.44
850.18
MW-41
2/14/1996
20.3
5.3-20.3
860.52
840.22
6/21/2012
7.89
852.63
MW-42
1/3/2006
35.0
30.0-35.0
865.32
830.32
6/21/2012
30.72
834.60
MW-43(D)
1/4/2006
53.0
48.0-53.0
865.47
812.47
6/21/2012
31.20
834.27
MW-44
4/5/2007
28.5
13.5-28.5
NM
-
6/21/2012
16.32
-
MW-45
9/7/2007
36.2
21.2-36.2
861.79
825.59
6/21/2012
28.13
833.66
MW-46
9/1/2011
32.7
22.7-32.7
856.73
824.03
6/21/2012
25.51
831.22
MW-47
11/29/2011
32.3
22.3-32.3
857.17
824.87
6/21/2012
24.35
832.82
MW-48
11/30/2011
30.4
20.4-30.4
844.07
813.67
6/21/2012
18.49
825.58
MW-49
12/1/2011
35.2
25.2-35.2
853.05
817.85
6/21/2012
26.44
826.61
MW-50
1/16/2012
19.65
9.65-19.65
834.67
815.02
6/21/2012
14.88
819.79
MW-51
1/13/2012
14.05
4.05-14.05
834.49
820.44
6/21/2012
12.12
822.37
MW-52
1/12/2012
13.75
3.75-13.75
831.87
818.12
6/21/2012
12.13
819.74
MW-53D
1/19/2012
46.0
41.0-46.0
857.48
811.48
6/21/2012
25.94
831.54
RW-1
6/13/1989
27.5
16.5-27.5
NM
-
11/1/2006
16.10
-
RW-2
6/19/1989
25.5
8.6-25.5
NM
-
11/1/2006
13.30
-
RW-3
2/13/1997
31.0
10.2-31.0
NM
-
11/1/2006
17.60
-
RW-4
2/15/1996
70.0
10.0-70.0
NM
-
11/1/2006
10.91
-
NOTES:
feet TOC = feet below top of well casing
NM = Not measured
97746
Copyright 2012 Kleinfelder July 25, 2012

TABLE 2: INORGANIC GROUNDWATER ANALYSIS
SAMPLE ID
MW-46
MW-47
MW-49
Collection Date
3/27/12
3/27/12
3/27/12
Metals by EPA Method 6010 (ug/1)
Iron (Dissolved)
BDL
376
59.4
COD by Standard Method 5220D (ug/1)
Chemical Oxygen Demand
54,000
113,000
66,000
BOD by Standard Method 5210B (ug/1)
Chemical Oxygen Demand
BDL
97,900
24,300
Anions by EPA Method 300.0 (ug/1)
Sulfate
30,000
12,400
20,000
NOTES:
BDL = Below Detection Limits
pg/L = Micrograms per liter, analogous to parts per billion
97746
Copyright 2012 Kleinfelder July 25, 2012

TABLE 3: INJECTION WELL APPLICATION RATES
Injection Well
Total Depth
(feet bgs)
Screened Interval
(feet bgs)
Quantity of
Injectant
(10:1 ratio)
(gallons)
Quantity of Municipal
Water to Distribute
Injectant
(gallons)
Total Volume
(gallons)
IW-1
35
20 - 35
240
480
720
IW-2
35
20 - 35
240
480
720
IW-3
35
20 - 35
280
560
840
IW-4
35
20 - 35
320
640
960
IW-5
35
20 - 35
360
720
1,080
IW-6
35
20 - 35
400
800
1,200
IW-7
35
20 - 35
360
720
1,080
IW-8
35
20 - 35
360
720
1,080
IW-9
35
20 - 35
320
640
960
IW-10
35
20 - 35
320
640
960
IW-11
35
20 - 35
320
640
960
IW-12
35
20 - 35
280
560
840
IW-13
35
20 - 35
280
560
840
IW-14
35
20 - 35
240
480
720
IW-15
35
20 - 35
240
480
720
IW-16
35
20 - 35
240
480
720
Total Volume
4,800
9,600
14,400
NOTES:
The infiltration rate at each well is anticipated to be approximately 0.5 to 1 gallon per minute at 5 to 10 pounds per square inch.
CcfO�Os��
97746
Copyright 2012 Kleinfelder July 25, 2012

FIGURES

SUPPORTING MATERIALS
PERMIT REISSUANCE
OF
APRIL 20, 2010

RECEIVED i DENR 1 DWO
State of North Carolina AQ0IFFP,PP0TFr.Tir)N SF.CT0N
Department of Environment and Natural Resources FEB 2 5 2010
Division of Water Quality
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
• Do not use this form for remediation systems that extract contaminated groundwater, treat it, and reinject the treated groundwater
• Submit TWO copies of the completed application and all attachments to the address on the last page of this form.
• Any changes made to this form will result in the application package being returned.
Application Number (to be completed by DW&
I. GENERAL INFORMATION:
H.
1. Applicant's Name (generally the responsible party): Gilbarco
2. Signing Official's Name*: Roy Walker Title: Vice President US Operations
* Signing Official must be in accordance with instructions in part VI on page 7.
3. Mailing address of applicant: 7300 West Friendly Avenue
City: Greensboro State: NC Zip: 27420-2087
Telephone number: 336.547.5130 Fax number: 336.547.3025
4. Property Owner's Name (if different from Applicant): Same
5. Property Owner's mailing address: Same
City:
State: Zip:
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Mr. Christopher W. Hay Title:_ Environmental Group Mg
Company: Kleinfelder Southeast Inc.
Address: 313 Gallimore Dairy Road
City: Greensboro State: NC Zip: 27409
Telephone number: 336.668.0093 Fax number: 336.668.3868
Email Address: [e-mail]
PERMIT INFORMATION:
1. Project is: ( New ( Modification of existing permit ( Renewal of existing permit without modification
( Renewal of existing permit with modification
2. If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number W10400091 and the issuance date March 20, 2008
For renewal without modifications, fill out sections I & II only, sign the certification on the last page of this
form, and obtain the property owner's signature to indicate consent (if the applicant is not the owner).
For all renewals, submit a status report including monitoring results of all injection activities to date.
Note: The most recent Quarterly HISOC Monitoring Report was submitted to the UIC Section on
Revised 6/09 January 4, 2010. UIC-5I/5T Page I of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type SI Wells — In Situ Groundwater Remedlation / Type ST Wells — Tracer Injection
VI. CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. for a partnership or sole proprietorship: by a general partner or the proprietor, respectively
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official
4. for all others: by the well owner.
If an authorized agent is signing an behalf of the applicant, then supply a letter signed by the applicant that
names and authorizes their agent.
I hereby certify under penalty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that there are penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection wells)
and all related appurtenances in accordance with the approved specifications and conditions of the Permit.
Printed Name and
Signature: Date; 1
VD. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("Owner" means any person who holds the fee or other property rights in the well being constructed. A well is
real property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing.)
As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(Title 15A NCAC 2C .0200).
Printed Name and Title: CX",s-
Signature:I,\
Date ci I-Lv-
REGi lI
Submit TWO copies of the completed application package, including all attachments, to:
A D/DENR/DWC
#�+t 'MOction SELL,.. , UIC Program
Z Aquifer Protection Section
2010 North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 6/09 MC-5I/5T Page 7 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Typo 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI. CERTIFICATION (to be signed as required below or by that person's authorized agent)
NCAC 15A 2C .0211(b) requires that all permit applications shall be signed as follows:
1. for a corporation: by a responsible corporate officer
2. fof a partnership or sole proprietorship: by a general partner or the proprietor, respectively
3. for municipality or a state, federal, or other public agency: by either a principal executive officer or
ranUng publicly elected official
4. for all dthers: by the well owner.
If an authorized agent Is signing on behalf of the applicant, then supply a letter signed by the applicant that
names and authorizes their agent.
I hereby certify under p6galty of law that I have personally examined and am familiar with the information
submitted in this document and all attachments therein, and that, based on my inquiry of those individuals
immediately responsible for ,obtaining said information, I believe that the information is true, accurate, and
complete. I am aware that them are penalties, including the possibility of fines and imprisonment, for submitting
false information. I agree to co"ct, operate, maintain, repair, and if applicable, abandon the injection well(s)
and all related appurtenances in acoprdance with the approved specifications and conditions of the Permit.
Printed Name and Title:
Signature: _ _ Date:
VII. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("Owner" means any person who holds the fee or other property rights in the well being constructed. A well is
real property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary agreement in writing.)
As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection wells) conform to the Well Construction Standards
(Title 15A NCAC 2C .0200).
Printed Name and
tJ,gli,, \J.,%-;,L.J. C��,4, N
Signature: ate: 14
Submit copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699.1636 RECEIVED /DEIR/DWO
Telephone [phone]R1N'11f>NSECTM
FEB 25 loco
Revised 6/09 UIC-51/5T Page 7 of 7

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
• Do not use this form for remediation systems that extract contaminated groundwater, treat it, and reinject the treated groundwater.
• Submit TWO copies of the completed application and all attachments to the address on the last page of this form.
• Any changes made to this form will result in the application package being returned.
Application Number (to be completed by DW&
I. GENERAL INFORMATION:
1. Applicant's Name (generally the responsible party): Gilbarco
2. Signing Official's Name: Paul J. Lemrners Title: Operations Manager
3. Mailing address of applicant: 7300 West Friendly Avenue
City: Greensboro
Telephone number: 336.547.5130
4. Property Owner's Name (if different from Applicant): Same
5. Property Owner's mailing address: Same
State: NC Zip: 27420-2087
Fax number: 336.547.3025
City: State: Zip:
6. Name and address of contact person who can answer questions about the proposed injection project:
Name: Mr. Christopher W. Hay Title: Natural Resources Dept. Mgr.
Company: Trigon Engineering Consultants, Inc.
Address: 313 Gallimore Dairy Road
City: Greensboro State: NC Zip: 27409
Telephone number: 336.668.0093 Fax number: 336.668.3868
Email Address: [e-mail] RECEIVED / DEN I DVVQ
P P6 iT 1 g 5. �-'"+ G o s' Z�, 12 AQUIFER PPr'r`rn., c.PCTION
II. PERMIT INFORMATION: ,�k Sf' �V.� AUG C cilU]
1. Project is: ❑x New Modification of existing permit Renewal of existing permit without modification
Renewal of existing permit with modification
2. If this application is being submitted for renewal or modification to an existing permit, provide:
existing permit number and the issuance date
For renewal without modifications, fill out sections I & II only, sign the certification on the last page of this
form, and obtain the property om ner's signature to indicate consent (if the applicant is not the owner).
For all renewals, you must submit a status report including monitoring results of all injection activities to
date.
Revised8/07 UIC-51/5T �te of7lcttst
Pa
b y r� �t„ z ►, g
l-c { 4 o N
rcc t f

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
III. INCIDENT & FACILITY DATA
A. FACILITY INFORMATION
1. Facility name: Gilbarco
C
2. Complete physical address of the facility: 7300 West Friendly Avenue
City: Greensboro County: Guilford State: NC Zip: 27409
INCIDENT DESCRIPTION
1. Describe the source of the contamination:
Former gasoline underground storage tanks (USTs) are primarily the source of contamination. The USTs have
been removed from the site.
2. List all contaminants present in soils or groundwater at the site (contaminants may be listed in groups, e.g.,
gasoline, diesel, jet fuel, fuel oil, chlorinated ethenes, chlorinated ethanes, metals, pesticides/herbicides, etc):
Chlorinated aliphatic hydrocarbons and gasoline constituents
3. Has LNAPL or DNAPL ever been observed at the site (even if outside the injection zone)?
❑x Yes If yes, list maximum measured separate phase thickness 0.1
❑ No If no, list maximum concentration of total VOCs observed at site:
ppb
4. Agency managing the contamination incident:
❑ UST Section ❑ Superfund Section (including REC Program and DSCA sites)
❑ DWQ Aquifer Protection Section -' Solid Waste Section
❑ Hazardous Waste Section ❑x Other: Guilford Co. Dept. of Environmental Health
5. Incident managers name Gene Mao
and phone number 336.641.3771
6. Incident number or other site number assigned by the agency managing the contamination incident:
Groundwater Incident Nos. 12960 and 15123
PERMITS
List all permits or construction approvals that have been issued for the facility or incident, including those not
directly related to the proposed injection operation:
1. Hazardous Waste Management program permits under RCRA: (LQG) NCDO01115245
2. DWQ Non -Discharge or NPDES permits: NPDES NCG 030000
3. County or DEH subsurface wastewater disposal permits: City of Greensboro Industrial WW:S-2010
4. Other environmental permits required by state or federal law: Well construction permit number WR04000162;
Recovery well permit number 042-96-MW17-RW4
Revised 8/07 UIC-51/5T Page 2 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
IV. INJECTION DATA
A. INJECTION FLUID DATA
1. List all proposed injectants.
NOTE: Any substance to be injected as a tracer or to promote in situ remediation must be reviewed by the
Occupational and Environmental Epidemiology Section (OEES) of the Division of Public Health, Department of
Health and Human Services. Review the list of approved injectantsT or contact the UIC Program to determine if
the injectants you are proposing have been reviewed by OEES.
Injectant: Hydrogen
Concentration at point of injection: 1.0 to 4.0 ppm dissolved hydrogen
Injectant: Oxygen [will begin after hydrogen phase is complete]
Concentration at point of injection: 50 to 90 ppm dissolved oxygen
Injectant:
Concentration at point of inj
Concentration at point of inj
Concentration at point of injection:
2. Source of fluids used to dilute or chase the injectants listed above:
x None
= Municipal water supply
C Groundwater from private well or any well within 'Amile of injection site
❑ Air
C Other:
3. If any well within 'Amile of injection site, a private well, or surface water is to be used as the fluid source, supply
the following information:
a. Location/ID number of source: NIA
b. Depth of source:
c. Formation:
d. Rock/Sediment type:
e. In Attachment C, provide a current, complete chemical analysis of the water from the source well, including
analyses for all contaminants suspected or historically recognized in soil or groundwater on the site.
NOTE: If contaminated groundwater is to be used as the dilution or chase fluid, this is not the proper permit
application form. You must apply for aclosed-loop groundwater remediation permit using application form
GWRS.
Revised 8/07 UIC-5I/5T Page 3 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
B. PROPOSED OPERATING PARAMETERS
1. Duration of Injection:
Maximum number of separate injection events: See Addendum
Expected duration of each injection event: unknown [<2L stand]
Expected duration between events (if more than one event): few weeks [H2 to 02]
2. Injection rate per well: See Addendum gallons per minute (gpm)
3. Total Injection volume: See Addendum gallons per day (gpd); gallons per event (if separate events)
4. Injection pressure: 5-10 pounds/square inch (psi)
5. Temperature at point of injection: Ambient air OF
6. Brief1v describe how the above narameters will be measured and controlled:
Monitoring of the injection system will consist of quarterly groundwater sampling events. Each monitoring event
will consist of inspecting the injection system and sampling groundwater for volatile organic compounds. During
each site visit the remaining cylinder pressure will be recorded along with HiSOC regulator pressure setting. p
7. Estimated hydraulic capacity of the well: N/A gpm
C. INJECTION WELL CONSTRUCTION DATA
1. Injection will be via:
❑x Existing well(s) proposed for use as an injection well. Provide the data in (2) through (6) below to the best of
your knowledge.
9 Proposed well(s) to be constructed for use as an injection well. Provide the data in (2) through (6) below as
proposed construction specifications.
2. Well Drilling Contractor's Name: Ronald Toothman
NC Well Contractor Certification number: 2075
3. Date to be constructed: September 2007 Number of borings:
Approximate depth of each boring (feet): 35
4. Screened interval/Injection interval of injection wells:
Depth: 20.0 to 58.8 feet below ground surface (if multiple intervals, indicate shallowest and deepest depth).
5. Well casing (N/A if injection is through direct push rods):
Type: *❑ PVC ❑ Stainless steel ❑ Other:
Casing depth: to ft.
6. Grout (N/A if injection is through direct push rods):
Type: rx Cement 91 Bentonite ❑ Other:
Grout depth: 0 to 19.0 ft.
Revised 8/07 UIC-5I/5T Page 4 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
V. ATTACHMENTS
Provide the following items as attachments with the given headings:
A. SITE HISTORY
Provide a brief description of the site history including:
(1) site usage historically and present,
(2) origin of the contamination,
(3) previous remedial action(s).
NOTE: G.S. 89E-18 requires that any geologic plans, reports, or documents in which the performance is related to the
public welfare or safeguarding of the environment be prepared by a licensed geologist or subordinate under his or her
direction. G.S. 89E-13 requires that all drawings, reports, or documents involving geologic work which shall have been
prepared or approved by a licensed geologist or a subordinate under his or her direction be signed and sealed by him or
her.
B. HYDROGEOLOGIC DESCRIPTION
Provide a hydrogeologic description, soils description, and cross section of the subsurface to a depth that includes the
known or projected depth of contamination. The hydrogeologic description shall include:
(1) the regional geologic setting;
(2) significant changes in lithology;
(3) the hydraulic conductivity, transmissivity, and specific yield of the aquifer to be used for injection, including a
description of the test(s) used to determine these parameters; and
(4) the depth to the mean seasonal high water table.
C. INJECTION FLUID COMPOSITION
Describe the chemical, physical, biological and radiological characteristics of each injectant. Attach the Material Safety
Data Sheet (MSDS) for each injectant. If a private well or a well within'/4 mile of the injection site is used as the source
well, include chemical analysis of source fluid here.
D. INJECTION RATIONALE
Attach a brief description of the rationale for selecting the injectants and concentrations proposed for injection, including:
(1) goals of the injection project;
(2) a description of the reactions between the injectants and the contaminants present including specific breakdown
products or intermediate compounds that may be formed by the injection; and
(3) summary results of modeling or testing performed to investigate the injectant's potential or susceptibility to change
(biological, chemical or physical) in the subsurface.
E. INJECTION PROCEDURE AND EQUIPMENT
Provide a detailed description of all planned activities related to the proposed injection including but not limited to:
(1) construction plans and materials;
(2) operation procedures;
(3) a detailed diagram of the surface and subsurface portions of the system; and
(4) a planned injection schedule.
F. MONITORING PLAN
Provide a plan for monitoring the results of the injection, including:
(1) a list of existing and proposed monitoring wells to be used;
(2) a list of monitoring parameters and analytical methods to be used; and
(3) a schedule for sampling to monitor the proposed injection.
NOTE: The selected monitoring wells must be located so as to detect any movement of injection fluids, process by-
products, or formation fluids outside the injection area or zone. The monitoring parameters should include the target
contaminants as well as secondary or intermediate contaminants which may result from the injection and other
parameters which may serve to indicate the progress of the intended reactions, such as pH, ORP, dissolved oxygen, and
Revised 8/07 UIC-51/5T Page 5 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 5I Wells — In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
other electron acceptors and donors. The monitoring schedule should be consistent with the pace of the anticipated
reactions and rate of transport of the injectants and contaminants.
G. WELL DATA
Provide a tabulation of data on all existing or abandoned wells within'/4 mile of the injection well(s) which penetrate the
proposed injection zone, including, but not limited to, monitoring wells and wells proposed for use as injection wells.
Such data shall include a description of each well's use (water supply, monitoring, etc), total depth, screened or open
borehole depth interval, and well construction or abandonment record, if available.
H. MAPS
Attach the following scaled, site -specific maps:
(1) Area map based on the most recent USGS 7.5' topographic map of the area, at a scale of 1:24,000 and
showing the location of the proposed injection site.
(2) Site map including:
a. all property boundaries;
b. all buildings within the property boundary;
c. existing and proposed injection wells or well field(s)
d. any existing sources of potential or known groundwater contamination, including waste storage,
treatment or disposal systems within'/4 mile of the injection well or well system;
e. all surface water bodies within'/4 mile of the injection well or well system; and
f. all existing or abandoned wells within'/4 mile of the injection well(s) which penetrate the proposed
injection zone, including, but not limited to, monitoring wells and wells proposed for use as injection
wells.
(3) Potentiometric surface map(s) including:
a. direction of groundwater movement
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(4) Contaminant plume map(s) including:
a. the horizontal extent of the contaminant plume, including isoconcentration lines
b. existing and proposed monitoring wells
c. existing and proposed injection wells
(5) Cross-section(s) to the known or projected depth of contamination, including:
a. horizontal and vertical extent of the contaminant plume, including isoconcentration lines
b. major changes in lithology
Revised 8/07 UIC-51/5T Page 6 of 7

08/28/2007 08:32 FAX
[A 002
APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELLS) FOR INJECTION
Type 51 Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI. CERTIFICATION
1, PA LA 1(9161t"MC Of arm ors , hereby certify under penalty of law that
I have personally examined and am familiar with the information submitted in this document and all attachments
thereto and that, based on my inquiry of those individuals immediately responsible for obtaining said information,
I believe that the information is true, accurate and complete. I am aware that there are significant penalties,
including the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well(s) and all related appurtenances in
accordance with the approved specifications and conditions of the Permit.
Signature: Date: a
Title: [5?
If authorized agent is acting on behalf of the applicant, supply a letter signed by the applicant authorizing the
above agent.
VIL CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("Owner" means any person who holds the fee or other property rights in the well being constructed. A well is
real property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary area eeme►rt in writing.)
a u ) � 4 Le-m me /'s
I, Onated name of nronow encua) , as owner of the property on which the
injection wel(s) are to be constructed and operated, hereby consent to allow the applicant to construct each
injection well as outlined in this application and agree that it shall be the responsibility of the applicant to ensure
that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC 2C .0200)
Signature: Date:
Title: of rZxA cam-, Z 14CV111 a s ,e
Submit TWO copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
RECEIVED; DENR/OWO
► oUiFFP Pvnrrrrrrw SECTION
AUG 29«01
Revised 8/07 UIC-51/5T Page 7 of 7

APPLICATION FOR PERMIT TO CONSTRUCT AND/OR USE A WELL(S) FOR INJECTION
Type 51 Wells —In Situ Groundwater Remediation / Type 5T Wells — Tracer Injection
VI. CERTIFICATION
I, Lt ��,:; : « apmc; i s�gni7r4 i'r� ,hereby certify under penalty of law that
I have personally examined and am familiar with the information submitted in this document and all attachments
thereto and that, based on my inquiry of those individuals immediately responsible for obtaining said information,
I believe that the information is true, accurate and complete. I am aware that there are significant penalties,
including the possibility of fines and imprisonment, for submitting false information. I agree to construct,
operate, maintain, repair, and if applicable, abandon the injection well(s) and all related appurtenances in
accordance with the approved specifications and conditions of the Permit.
Signature; z Date: 222 ,T<JG'
Title:_!. Djj y�h n r.r r
If authorized agent is acting on behalf of the applicant, supply a letter signed by the applicant authorizing the
above agent.
VII. CONSENT OF PROPERTY OWNER (if the property is not owned by the applicant)
("Owner " means any person who holds the fee or other property rights in the well being constructed. A well is
real property and its construction on land shall be deemed to vest ownership in the land owner, in the absence of
contrary a eement in writing.)
rcrel ) Le— mn,2
I, 131 n 1„c "If inn+ nr!� ar!itr! rs as owner of the property on which the
injection well(s) are to be constructed and operated, hereby consent to allow the applicant to construct each
injection well as outlined in this application and agree that it shall be the responsibility of the applicant to ensure
that the injection well(s) conform to the Well Construction Standards (Title 15A NCAC 2C .0200)
Signature: �t , Date: � _a
Title: 'Die AQ3 5 lcs v1 412 f e
Submit TWO copies of the completed application package, including all attachments, to:
UIC Program
Aquifer Protection Section
North Carolina DENR-DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone [phone]
Revised 8/07 UIC-51/5T Page 7 of 7

►� 1

3-D Microemulsion (3DMe)Tm
MATERIALS SAFETY DATA SHEET
last Revised: March 26, 2007
Section 1- Material Identification
Supplier-!
1011 Calle Sombra
San Clemente, CA 92673
Phone: [phone]
Fax: [phone]
E-mail: [e-mail]
• Glycerides, di-, mono [2-[2-[2-(2-hydroxy- l -oxopropoxy)-1-oxopropoxyl]-1-
oxopropoxy]propanoates]
Chemical Name(s): • Propanoic acid, 2-[2-[2-(2-hydroxy- l -oxopmpoxy)-1-oxopropoxy]-1-
oxopropoxy]-1,2,3-propanetriyl ester
• Glycerol
Chemical Family: Organic Chemical
Trade Name: 3-D Microemulsion (3DMe)Tm
Synonyms: HRC AdvancedTm HRC-PED (Hydrogen Release Compound - Partitioning
Electron Donor)
Product Use: Used to remediate contaminated groundwater (environmental applications)
Section 2 - Chemical Identification
.S# Chemical
823190-10-9 HRC-PED
61790-12-3 or
112-80-1 Fatty Acids (neutralized)
201167-72-8 Glycerol Tripolylactate
56-81-5 Glycerol

Regenesis — 3-1) Microemulsion MSDS
Section 3 — Physical Data
Melting Point: Not Available (NA)
Boiling Point: Not determined (ND)
Flash Point: > 200 °F using the Closed Cup method
Density: 0.9 -1.1 g/cc
Solubility: Slightly soluble in acetone. Insoluble in water.
Appearance: Amber semi -solid.
Odor: Not detectable
Vapor Pressure: None
Section 4 — Fire and Explosion Hazard Data
Extinguishing Media: Use water spray, carbon dioxide, dry chemical powder or appropriate foam
to extinguish fires.
Water May be used to keep exposed containers cool.
For large quantities involved in a fire, one should wear full protective clothing and a NIOSH approved
self contained breathing apparatus with full face piece operated in the pressure demand or positive
pressure mode as for a situation where lack of oxygen and excess heat are present.
Section 5 — Toxicological Information
May be harmful by inhalation,
irritation. To the best of ou
MAS050000
RTECS#
Glycerol
SKN-RBT 500 MG/24H MLD
Irritation Data: EYE-RBT 126 MG MLD
EYE-RBT 500 MG/24H MLD
r
85JCAE-,207,1986
BIOFX* 94/1970
85JCAE-,207,1986

Regenesis — 3-D Micmemulsion MSDS
Section 5 — Toxicological Information (cont)
ORL-MUS LD50:4090 MG/KG
FRZKAP (6),56,1977
SCU-RBT LD50:100 MG/KG
NHRDN 6,215,1982
ORL-RAT LD50:12,600 MG/KG
FEPRA7 4,142,1945
IHL-RAT LC50: >570 MG/M3/1H
BIOFX* 9-4/1970
IPR-RAT LD50: 4,420 MG/KG
RCOCB8 56,125,1987
IVN-RAT LD50:5,566 MG/KG
ARZNAD 26,1591,1976
Toxicity Data: IPR-MUS LD50: 8,700 MG/KG
ARZNAD 26,1579,1978
SCU-MUS LD50:91 MG/KG
NHRDN 6,215,1982
IVN-MUS LD50:4,250 MG/KG
JAPMA8 39,583,1950
ORL-RBT LD50: 27 MG/KG
DMDJAP 31,276,1959
SKN-RBT LD50: >10 MG/KG
BIOFX* 9-4/1970
IVN-RBT LD50: 53 MG/KG
NHRDN 6,215,1982
ORL-GPG LD50: 7,750 MG/KG
JIHTAB 23,259,1941
Behavioral (headache), gastrointestinal
(nausea or vomiting), Paternal
Target Organ Data: effects (spermatogenesis, testes, epididymis, sperm duct), effects of fertility
(male fertility index, post -implantation mortality).
Only selected registry of toxic effects of chemical substances (RTECS) data is presented here. See
actual entry in RTECS for complete information on lactic acid
and glycerol.
Fatty Acids
Acute oral (rat) LD50 value for fatty acids is 10000 mg/kg. Aspiration of liquid may cause
pneumonitis. Repeated dermal contact may cause skin sensitization.
Section 6 — Health Hazard Data
One should anticipate the potential for eye irritation and skin irritation with large scale exposure or in
sensitive individuals. Product is not considered to be combustible. However, after prolonged contact
with highly porous materials in the presence of excess heat, this product may spontaneously combust.
Handling: Avoid continued contact with skin. Avoid contact with eyes.
In any case of any exposure which elicits a response, a physician should be consulted immediately.
First Aid Procedures
Inhalation: Remove to fresh air. If not breathing give artificial respiration. In case of
labored breathing give oxygen. Call a physician.
Ingestion: No effects expected. Do not give anything to an unconscious person. Call a

Regenesis — 3-1) Microemulsion MSDS
physician immediately. DO NOT induce vomiting.
Section 6 — Health Hazard Data (cont)
Skin Contact: Flush with plenty of water. Contaminated clothing may be washed or dry
cleaned normally.
Eye Contact: Wash eyes with plenty of water for at least 15 minutes lifting both upper
and lower lids. Call a physician.
Section 7 — Reactivity Data
Conditions to Avoid: Strong oxidizing agents, bases and acids
Hazardous Will not occur.
Polymerization:
Further Information: Hydrolyses in water to form lactic acid, glycerol and fatty acids.
Hazardous Decomposition Thermal decomposition or combustion may produce carbon monoxide
Products: and/or carbon dioxide.
Section 8 — Spill, Leak or Accident Procedures
After Spillage or Neutralization is not required. The material is very slippery. Spills should
Leakage: be covered with an inert absorbent and then be placed in a container. Wash
area thoroughly with water. Repeat these steps if slipperiness remains.
Laws and regulations for disposal vary widely by locality. Observe all
Disposal: applicable regulations and laws. This material may be disposed of in solid
waste. Material is readily degradable and hydrolyses in several hours.
No requirement for a reportable quantity (CERCLA) of a spill is known.
Section 9 — Special Protection or Handling
Should be stored in plastic lined steel, plastic, glass, aluminum, stainless steel, or reinforced fiberglass
containers.
Protective Gloves: Vinyl or Rubber
Eyes: Splash Goggles or Full Face Shield. Area should have approved means of
washing eyes.
Ventilation: General exhaust.
Storage: Store in cool, dry, ventilated area. Protect from incompatible materials.

Regenesis — 3-D Micmemulsion MSDS
Section 10 — Other Information
This material will degrade in the environment by hydrolysis to lactic acid, glycerol and fatty acids.
Materials containing reactive chemicals should be used only by personnel with appropriate chemical
training.
The information contained in this document is the best available to the supplier as of the time of
writing. Some posslble hazards have been determined by analogy to similar classes of material. No
separate tests have been performed on the toxicity of this material. The items in this document are
subject to change and clari5cation as more information becomes available.

SUPPORTING MATERIALS
PERMIT REISSUANCE
OF
APRI L 20, 2010

APPLICATION FOR PERMIT TO CONSTRUCTION AND/OR USE A WELL[S] FOR INJECTION
ADDENDUM
B. PROPOSED OPERATING PARAMETERS
1. Duration of Injection:
Maximum number of separation injection events: 2 [1 for H2; 1 for 021
2. Injection rate per well: 28 cm3/min H2; 15 cm3/min 02
3. Total injection volume: 40,320 cm3/day H2; 21,600 cm3/day
C. INJECTION WELL CONSTRUCTION DATA
5. Well casing (N/A if injection is through direct push rods):
Casing depth: 0 to 20.0 ft

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 hest Friendly Avenue, Greensboro, .Forth Carolina Trigon Project No. 042-06-216
ATTACHMENT A: SITE HISTORY
The site is located at 7300 West Friendly Avenue in Greensboro, Guilford County, North Carolina
(Attachment H: Figure 1). The site (Parcel Number 00-94-7029-0-0961-00-007) is approximately 37.57
acres in size. The site consists of a fuel pump dispenser manufacturing facility consisting of
approximately 600,000 square feet of manufacturing, assembling, and warehouse space.
Several underground storage tanks (USTs) have been removed from the site. A leak was detected from a
gasoline UST in 1986. Several monitoring wells were installed to assess the extent of contamination and
recovery wells RW-1, RW-2, and RW-3 were installed at the site. Trigon Engineering Consultants, Inc.
(Trigon) has been contracted to work at the site since 1994 when a release was detected from a 1,000-
gallon diesel fuel UST. The 1,000-gallon diesel fuel UST was removed from the site in November 1994
and four 550-gallon gasoline USTs were removed in December of 1994. A Notice of Violation (NOV)
was issued by the North Carolina Department of Environment and Natural Resources (NCDENR) as a
result of the release from the 1,000-gallon diesel UST and four 550-gallon gasoline USTs. Trigon
completed a 20-Day Report dated October 11, 1994 and an UST Closure Report dated December 8, 1994
for the 1,000-gallon diesel tank release. An UST Closure Report dated January 31, 1995 was completed
for the four 550-gallon gasoline tanks. A Comprehensive Site Assessment (CSA) report dated March 21,
1995 and a revised CSA dated October 6, 1995 were completed for the site. A Corrective Action Plan
(CAP) dated October 17, 1996 was prepared in response to the NOV. Additional monitoring wells and
recovery well RW-4 were constructed at the site during the site investigation and remediation. Initial
remedial action with regard to the 1,000-gallon diesel fuel UST and the four 550-gallon gasoline USTs
included a free product recovery system installed adjacent to the diesel fuel UST. This system removed
approximately 220 gallons of free product (diesel fuel) from 400 gallons of an oil and water mixture.
The free product recovery system has been removed.
During the CSA, Trigon determined the extent of impacted groundwater through the installation of seven
Type I groundwater monitoring wells (MW-26, 28, 29, 31, 32, 33, and 34) and two Type III monitoring
wells (MW-27 and MW-30). The contaminant plume was approximately 300 feet in length east to west
and approximately 200 feet north to south. The vertical extent of groundwater contamination was in
excess of 73.4 feet which was the deepest sampling point used in this investigation. However, the
contaminant levels at a depth of 73.4 feet were only slightly above 2L groundwater standards.
TRIGONENGINEERING CONSUL TANTS, INC. A-1

Mr. Peter Pozzo, NC DENR-DWQ August 18, 1007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 041-06-116
At the time the CAP was prepared, a pump and treat groundwater remediation system was already
operating due to prior releases on the site. Therefore, the recommended corrective action at the site
included the installation of an additional recovery well and using the existing pump and treat system.
The treatment system consists of an oil/water separator that is connected to a holding tank. Free product,
if any, flows into a separate holding tank. The groundwater then passes through an aeration basin for
treatment. Treated groundwater then passes through a flowmeter before being discharged to the sanitary
sewer.
In 1996 additional tank closures at the site included a 20,000-gallon UST and several USTs within a tank
farm. One 20,000-gallon fuel oil tank was removed from the site and the incident was closed by the State.
In a separate investigation, 2,203 tons of petroleum impacted product was removed from the site in 1996
when the gas lab tank farm was removed. The tank farm consisted of four 2,000-gallon and two 5,000-
gallon gasoline USTs that formerly contained diesel fuel.
There are currently two open groundwater incidents (Incident #s 12960 and 15123). The incidents have a
commingled plume and are being treated with the same remediation plan. The pump and treat system is
currently operating at the site. The site was considered low risk by the State and no monitoring reports
were required; however, the property owner voluntarily monitored the remediation process.
Groundwater samples have periodically been collected from the monitoring wells at the site. The
monitoring well locations are shown on Figure 2 (Attachment H). Monitoring wells MW-7, MW-10,
MW-11, MW-12, MW-12D, MW-13, MW-13D, MW-14, MW-14D, MW-15, MW-16, MW-23D, MW-
24, MW-25, MW-27, MW- 28, MW-29, MW-30, MW-31, MW-32, MW-34, MW-40, MW-41, MW-42,
and MW-43D and recovery wells (RW-1, RW-2, RW-3, and RW-4) have generally been sampled
annually since 2002. Twenty two of the twenty four monitoring wells have historically had VOC
concentrations exceeding the State 2L Standards with the highest total VOC concentrations in monitoring
wells MW-7, MW-24, MW-28, MW-31, MW-32, and MW-41. In August 2006, laboratory analysis of
the groundwater sample collected from monitoring well MW-32 had significantly higher concentrations
of MTBE (increased from 180 ppb to 15,000 ppb). The well was sampled again in November of 2006 to
confirm these results. In order to collect additional information and assess the potential origin of the
MTBE, an Aggressive FluidNapor Recovery (AFVR) event was performed at monitoring well MW-32
over a period of eight hours on December 7, 2006. Monitoring wells MW-7, MW-28, and MW-32 were
then sampled again on December 14, 2006. Laboratory analytical results from the sampling even
TRIGON ENGINEERING CONSULTANTS, INC. A-1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
determined MTBE levels in monitoring wells MW-7 and MW-28 were below laboratory detection limits.
The MTBE concentration from the groundwater sampled collected from MW-32 was consistent with the
previous laboratory results.
The source of the increased MTBE concentrations is unknown. Monitoring well MW-44 was installed
upgradient of monitoring well MW-32 on April 5, 2007 and was sampled on April 11, 2007. Laboratory
analysis of the groundwater sample did not detect volatile organic compounds above the State standards
in monitoring well MW-32. The August 2006 sampling data is summarized in Tables 2 and 3 and the
total VOC concentrations are shown on Figure 5 (Attachment H). The historical data is summarized in
Table 4.
TRIGON ENGINEERING CONSULTANTS, INc. A-3

Mr. Peter Pozzo, NC DENR-DWQ
Gilbarco 7300 West Friendly Avenue, Greensboro, North Carolina
August 28, 2007
Trigon Project No. 042-06-216
ATTACHMENT B: HYDROGEOLOGIC DESCRIPTION
REGIONAL GEOLOGY AND HYDROGEOLOGY
The site is located in the Carolina Slate Belt of the Piedmont Physiographic Province of North Carolina.
The surficial geology consists of residual soil that has formed from the in -place chemical and physical
weathering of the underlying bedrock. The surrounding topography consists of rolling land and broad
ridges. According to the Geologic Map of North Carolina, the regional bedrock generally consists of
metamorphosed granitic rock (Brown and others, 1985). Groundwater generally flows to the north
discharging into Horsepen Creek.
SITE GEOLOGY AND HYDROGEOLOGY
A low permeability aquifer is present beneath the site. Lithologic information collected during the
investigative activities indicates that the aquifer predominantly consists of fine to medium grained sandy
silt. Weathered rock and bedrock were encountered during monitoring well installation. The water table
is approximately 7 to 30 feet below the ground surface.
The most recent static water level measurements are summarized in Table 1. Potentiometric surface maps
produced with the August 23, 2006 and November 1, 2006 water level data (Figures 3 and 4) indicated
that the groundwater flow direction at the site is generally from the southeast to the northwest under a
gradient of 0.02 feet per foot (ft/ft) as measured between MW-33 and MW-16. The groundwater
potentiometric maps also indicate the capture zones of the recovery wells extend approximately 30 feet
horizontally. Cross -sections for the site are shown on Figures 6, 7, and 8 (Attachment H). The available
soil boring logs and well construction records are included in Attachment G: Well Data.
Estimates of aquifer hydraulic conductivity, transmissivity, and storativity were calculated by the
analysis of data collected during a 4-hour pump test conducted on March 6, 1996. Recovery well RW-4
was used as the pumping well. Four monitoring wells were used as observation points, MW-26, MW-27,
MW-28, and MW-31. A Myers Submersible Pump was used for water extraction during the test.
Drawdown measurements were collected using an In -Situ Hermit 2000 Data -Logger. Pressure
transducers were placed in the pumping well and in each observation well. Following the pump test,
recovery data was collected during a 4.33 hour recovery test. A transmissivity value of 0.003 square feet
TRIGONENG/NEERLNG CONSULTANTS, INC. B-1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
per minute (ft2/min) and a storativity of 0.0003 were calculated using the Moench Solution in
AQTESOLVTM from data obtained from recovery well RW-4 and monitoring well MW-27.
The hydraulic conductivity (K) was calculated to be 0.086 feet per day (ft/day) using K=T/b where T is
the transmissivity and b is 56.42 feet, the thickness of the aquifer. The hydraulic conductivity value was
used to calculate the average linear horizontal groundwater velocity at the site. Using the value of 0.086
ft/day for the hydraulic conductivity, the horizontal hydraulic gradient of 0.02 ft/ft calculated between
monitoring wells MW-33 and MW-16, and an estimated effective porosity of 0.3, the average linear
horizontal groundwater velocity was calculated to be 6x10-3 ft/day or 2 feet per year.
TR/GON ENGINEER/NG CONSULTANTS, INC. B-1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
ATTACHMENT C: INJECTANT COMPOSITION
The injectants for the remediation system are hydrogen (H2) and oxygen (02). Hydrogen will be used in
the first phase for treatment of chlorinated hydrocarbons. The system will then be converted to oxygen
for treatment of petroleum hydrocarbons. The oxygen and hydrogen will be laboratory grade gases
delivered to the site in cylinders.
HYDROGEN
In normal conditions hydrogen is a colorless, odorless, and nontoxic gas, formed by diatomic molecules,
H2. Common hydrogen has a molecular weight of 2.01594 grams. As a gas it has a density of 0.005611
lb/ft3 at 32°F and 1 atm. The relative density, compared with that of the air, is 0.0695. Hydrogen is the
most flammable of all the known substances. At normal temperature hydrogen is a not very reactive
substance, unless it has been activated by an appropriate catalyser. At high temperatures it's highly
reactive.
Effects of exposure to hydrogen: Fire: Extremely flammable. Many reactions may cause fire or explosion.
Explosion: Gas/air mixtures are explosive. Routes of exposure: The substance can be absorbed into the
body by inhalation. Inhalation: High concentrations of this gas can cause an oxygen -deficient
environment. Individuals breathing such an atmosphere may experience symptoms which include
headaches, ringing in ears, dizziness, drowsiness, unconsciousness, nausea, vomiting and depression of
all the senses. The skin of a victim may have a blue color. Under some circumstances, death may occur.
Hydrogen is not expected to cause mutagenicity, embryotoxicity, teratogenicity or reproductive toxicity.
Pre-existing respiratory conditions may be aggravated by overexposure to hydrogen. Inhalation risk: On
loss of containment, a harmful concentration of this gas in the air will be reached very quickly.
Physical dangers: The gas mixes well with air, explosive mixtures are easily formed. The gas is lighter
than air.
Chemical dangers: Heating may cause violent combustion or explosion. Hydrogen reacts violently with
air, oxygen, halogens and strong oxidants causing fire and explosion hazard. Metal catalysts, such as
platinum and nickel, greatly enhance these reactions.
Mc,oNENGINEER/NG CONSULTANTS, 1Nc. C -1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
High concentrations in the air cause a deficiency of oxygen with the risk of unconsciousness or death.
Check oxygen content before entering area. No odor warning if toxic concentrations are present.
Measure hydrogen concentrations with suitable gas detector (a normal flammable gas detector is not
suited for the purpose).
First aid: Fire: Shut off supply; if not possible and no risk to surroundings, let the fire burn itself out; in
other cases extinguish with water spray, powder, carbon dioxide. Explosion: In case of fire: keep cylinder
cool by spraying with water. Combat fire from a sheltered position. Inhalation: Fresh air, rest. Artificial
respiration may be needed. Refer for medical attention. Skin: Refer for medical attention.
OXYGEN
In normal conditions oxygen is a colorless and odorless gas. Non -combined gaseous oxygen normally
exists in form of diatomic molecules, 02, but it also exists in triatomic form, 03 or ozone. Oxygen gas
makes up a fifth of the atmosphere. Nearly every chemical, apart from the inert gasses, bind with oxygen
to form compounds. It is moderately soluble in water (30 cm3 per 1 liter of water dissolve) at 20 Celsius.
Oxygen has a low boiling/ condensing point:-297.3°F (-183°C). The gas is approximately 1.1 times
heavier than air and is slightly soluble in water and alcohol. As a gas it has a density of 0.089212 lb/ft3 at
32°F and 1 atm. Below its boiling point, oxygen is a pale blue liquid slightly heavier than water.
Effects of exposure to hydrogen: Inhalation risk: Every human being needs oxygen to breathe, but too
much is not good. If one is exposed to large amounts of oxygen for a long time, lung damage can occur.
Breathing 50-100% oxygen at normal pressure over a prolonged period causes lung damage.
Fire/Explosion: Highly concentrated sources of oxygen promote rapid combustion and therefore are fire
and explosion hazards in the presence of fuels.
Chemical dangers: Oxygen is highly oxidizing (a general chemical term applying to any substance, like
oxygen, that accepts electrons from another substance during reaction). Oxygen reacts vigorously with
combustible materials, especially in its pure state, releasing heat in the reaction process. Many reactions
require the presence of water or are accelerated by a catalyst.
TR/GON ENGINEER/NG CONSULTANTS, INC. C-2

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco 7300 West Friendly Avenue, Greensboro. North Carolina Trigon Project No. 042-06-216
ATTACHMENT D: INJECTION RATIONALE
Since both chlorinated aliphatic hydrocarbons and petroleum hydrocarbons are present within the
contaminated groundwater at the site, it is necessary to use both hydrogen (HiSOCT) and oxygen
(iSOC®) for remediation of the site. HiSOC®/iSOC" systems have not been documented in the Piedmont
so we do not have reference data from soils with similar permeabilities. However, the installation of this
equipment in Raleigh, North Carolina is being monitored by North Carolina State University staff.
Additionally, the US Air Force has a progressive program to experiment with innovative technology.
Many of their sites have experimented with the equipment and they have endorsed the use of the units at
all their facilities.
Sparging is widely recognized as a groundwater treatment method that has been used since the early
1990's. Sparging generally consisted of blowing air out through a well system to provide gas (generally
oxygen) to treat petroleum hydrocarbons. The HiSOC"/iSOC® units improve the efficiency of
distributing the gas by diffusing it at a size where it is readily available to dissolve into the groundwater
and travel with the groundwater. The limiting factor with sparging is that gas is expelled in bubbles,
which travel to the top of the water column through preferential pathways and the majority of the gas is
released or trapped without benefit. Because the HiSOC"/600 units diffuse the gas at such a small
size, the water will become super -saturated, the gas will not be released or trapped, and the gas will flow
with the groundwater creating a much larger effective radius of treatment.
Trigon completed a natural attenuation sampling event on May 3, 2007 at the outset of designing the
Remedial Action Plan. Selected monitoring wells were sampled for dissolved gases, electron acceptors,
and field parameters which indicate whether to expect any competing uses for hydrogen, limiting factors
for the chemistry, and subsurface conditions to determine if the existing conditions are favorable. The
injection system was designed for the site based on the results of the natural attenuation sampling. The
results are summarized in Tables 5 and 6.
HYDROGEN
The in situ groundwater bioremediation process relies on microorganisms (soil bacteria) that are
stimulated by adding electron donors and changing prevailing redox conditions where necessary, leading
TRIGON ENGINEERING CONSULTANTS, INC. D-1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
to biological contaminant degradation in groundwater. Highly oxidized chlorinated aliphatic
hydrocarbons (CAHs) such as tetrachloroethene (PCE) and lower CAHs are used as electron acceptors in
the anaerobic process of biologically mediated reductive dechlorination. During the anaerobic biological
process, hydrogen substitutes for a chlorine ion on the PCE molecule forming TCE, which can be further
reduced to DCE, VC and ethene. The effect of electron donor addition depends on electron acceptors
present. Competing electron acceptors include dissolved oxygen (DO), nitrate, ferric iron (Fe3+) and
manganese IV must be reduced to reach favorable conditions for reductive dechlorination.
Reductive Dechlorination Process
Anaerobic reductive dechlorination of CAHs using hydrogen as an electron donor
proceeds by the following generalized reaction:
H2 + R-C-CI => R-C-H + H+ + Cl
Where C-Cl represents a carbon -chloride bond in a chlorinated molecule, C-H represents
a carbon -hydrogen bond, and R represents the remainder of the molecule. In these
reactions, two electrons are transferred with molecular hydrogen (H2) as the electron
donor (which is oxidized) and the chlorinated molecule (R-C-CI) as the electron acceptor
(which is reduced).
(AFCEE 2004)
This chemical reaction is happening naturally at the site. However, it is unknown how quickly the
process is taking place. The goal is to make sure there is an adequate supply of hydrogen to allow the
chemistry to take place as well as pacify the other natural consumers of hydrogen in the subsurface. The
Remedial Action Plan is designed to deliver hydrogen to the subsurface specifically to key areas where
treatment is most needed and natural hydrogen levels are low or depleted.
The reductive dechlorination of CAHs in groundwater is implemented at a site by the infusion of
hydrogen as an electron donor with the HiSOC® Gas inFusion delivery system. If not already present,
anaerobic conditions are generated by the delivery of hydrogen. Sufficient mass of hydrogen must be
delivered to satisfy hydrogen demand, calculated from estimates of competing electron acceptors and
CAH mass present in the treatment zone. Where appropriate this calculation includes the mass of
electron acceptors in the dissolved and solid phase within the treatment area and the mass flux of electron
acceptors into the treatment area with groundwater flow. The required mass of hydrogen can then be
compared to rates of hydrogen delivery by HiSOC®s to determine the appropriate number of treatment
TRIGON ENGINEERING CONSULTANTS, INC. D-2

Xfr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project ,'fib. 042-06-216
units necessary for the projected treatment time frame. The design layout and number of treatment wells
must also be developed in consideration of site specific hydrogeologic conditions.
On a mass basis, 1.0 gram of molecular hydrogen is sufficient to dechlorinate the following mass of
CAHs, assuming 100 percent utilization of molecular hydrogen by the dechlorinating microorganisms:
• 20.6 grams of PCE to ethene
• 21.7 grams of TCE to ethene
• 24.0 grams of DCE to ethene
• 31.0 grams of VC to ethene
Competing electron acceptors may be dissolved in groundwater or present as a solid. One gram of
molecular hydrogen is also sufficient to reduce the following mass of competing electron acceptors:
• 7.9 grams of oxygen
• 10.2 grams of nitrate
• 55.9 grams of Iron III (reduced to Fe(II) - aquifer solid demand)
• 27.5 grams of Manganese IV (reduced to Mn(III) - aquifer solid demand)
• 10.6 grams of sulfate
• 5.5 grams of carbon dioxide
(AFCEE 2004)
A detailed procedure for evaluation of hydrogen demand is included in Principles and Practices of
Enhanced Anaerobic Bioremediation of Chlorinated Solvents
Prepared by the Air Force Center for Environmental Excellence (AFCEE), 2004
http:lf www. afc ee.brooks.af. mi Upro ducts/tec htransB i oremed iat ion/B IOREMresourc es. asp
OXYGEN
The in situ groundwater bioremediation process relies on microorganisms (soil bacteria) that are
stimulated through the control of environmental factors to reduce contaminant concentrations in
groundwater. These soil bacteria utilize petroleum hydrocarbons as a source of carbon for biomass
production and energy. In aerobic processes, terminal electron acceptors such as dissolved oxygen and
where necessary other essential nutrients can be delivered to groundwater to enhance natural attenuation
of fuel related hydrocarbons, including gasoline constituents benzene, toluene, ethylbenzene and total
xylenes (BTEX), methyl tertiary butyl ether (MTBE) and tertiary butyl alcohol (TBA), polycyclic
TRIGON ENGINEERING CONSULTANTS, INC. D-3

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
aromatic hydrocarbons (PAH) and a variety of other hydrocarbons. In -situ bioremediation technology has
been extensively studied and applied since the mid 1980's.
The microbiological enzymatic oxidation of a hydrocarbon results in a fatty acid or carboxylic acid.
When microbes biodegrade hydrocarbons, the following chemical reaction occurs:
C-C-C-C-C-C-C-C-C-C
to
C-C-C-C-C-C-C-C-C-C-OOH
decane to decanoic acid
N N
N N N pQll
H N
benzene rings to catechol
These fatty or carboxylic acids are then further broken down for energy and carbon by beta oxidation,
which removes two carbon atoms at a time as follows (oxygen requirement for the first step of
bioremediation to a fatty acid is minimal, requiring only 2 or 4 atoms per hydrocarbon molecule).
R-C-C-C-COOH b R-C-COOH + C-COOH b CITRIC ACID CYCLE
The two carbon atoms are accepted in the citric acid cycle that produces energy and carbon for protein.
Final end products of hydrocarbon biodegradation are energy, protoplasm, carbon dioxide, and water.
Enhanced bioremediation stimulated by the infusion of dissolved oxygen has been proven to be an
effective technology to reduce all forms of dissolved hydrocarbons in groundwater. The efficient delivery
of dissolved oxygen into ground water is essential to insure that an abundance of oxygen is available for
the bioremediation process at a reasonable cost.
TRIGON ENGINEERING CONSULTANTS, 1NC. D-4

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
ATTACHMENT E: INJECTION PROCEDURE AND EQUIPMENT
The HiSOC®/iSOO gas delivery system is based on inVenture's patented Gas inFusion technology - a
unique method of infusing supersaturated levels of dissolved gas into liquids. At the heart of
HiSOC®/iSOC®is a proprietary structured polymer mass transfer device that is filled with micro -porous
hollow fiber material that provides an enormous surface area for mass transfer - in excess of 7000
m2/m3. It is hydrophobic and therefore excludes water. The system efficiently delivers gas to liquid by
mass transfer without sparging.
HiSOC®/iSOC® is constructed of high quality SS316 stainless steel using the latest manufacturing
equipment and a proprietary structured polymer mass transfer device. HiSOC®/iSOC® is 1.62" (41 mm)
in diameter and 12.65" (321 mm) long with a fitting for connection to Paraflex natural gas hose used in
the treatment well. The Paraflex is connected to stainless steel tubing at the surface for connection to the
gas supply. The housings for the pressure and flow control unit and the drain plug are made from nylon.
HiSOC®/iSOC® has a lifting ring for connecting to a suspension line for insertion in 2" (50 mm) or larger
monitoring wells.
DELIVERY OF HYDROGEN WITH THE HiSOC9 SYSTEM
Enhanced bioremediation stimulated by the infusion of dissolved hydrogen is an effective technology to
reduce dissolved CAHs in groundwater. The efficient delivery of dissolved hydrogen into groundwater
is essential to insure that an abundance of hydrogen is available for the bioremediation process safely and
at a reasonable cost.
Trigon will install ten HiSOC® diffusers in existing monitoring wells (MW-7, MW -10"MW-i , MW-
14D, MW-15, MW-16, MW-24, MW-29, MW-34, and MW-43D) at the site. The proposed iSOC®
installation locations are shown on Figure 9. Initially, our emphasis will be to deliver hydrogen to
enhance the subsurface environment for the anaerobic degradation of chlorinated solvents. The HiSOC®
units will be ordered and shipped from InVentures Technologies, Inc. The existing well covers at the
HiSOC® installation locations will be removed and pavement will be cut to accommodate the installation
of protective vaults. The following equipment will be installed within each vault: HiSOC® units with
tubing and wire leads, well caps, hydrogen regulators with barbed hose fittings for purging the system
TRIGON ENGINEERING CONSULTANTS, INC. E -1

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
with nitrogen, and a hydrogen cylinder and casing. The HiSOC® units will diffuse hydrogen into the
selected existing wells until chlorinated aliphatic hydrocarbons are reduced to acceptable levels within
groundwater at the site. To maximize the efficiency of this system, HiSOO units may be relocated.
This may require modification of additional wells in the future.
In anaerobic bioremediation applications, the HiSOC® supersaturates the treatment well with dissolved
hydrogen, typically 1.0 to 4.0 PP%1 depending on the immersion depth of the HiSOO unit in
groundwater. The HiSOO produces a convection current in the well with a designed release bubble from
the top of the HiSOC® to distribute dissolved hydrogen rich water throughout the screened interval. A
curtain of hydrogen rich water disperses around the well into the adjacent groundwater forming a
treatment zone and enhanced bioremediation removes target contaminants. Placement of injection wells
depends on site -specific conditions and treatment objectives as described further below. Treatment well
screens typically span the full thickness of the contaminated groundwater zone. The HiSOO system is
installed in a few hours to days depending on the number of treatment wells. HiSOO units are easily
moved from well to well to optimize performance and remediation strategies.
The dissolved hydrogen concentration achieved in the treatment well depends on the height of the water
column in the well. Each atmosphere of pressure allows for a maximum of approximately 1.6 ppm of
dissolved hydrogen. Hydrogen is continuously infused into the aquifer over a period of several months to
up to several years, as needed. During this time, a large and continuous supply of hydrogen is infused
into the groundwater system to provide significant enhanced degradation of target CAHs. Hydrogen is
infused from the HiSOC® into the treatment well at a typical rate of 28 standard cubic
centimeters/minute.
A HiSOC® system does not require electrical power, does not generate any noise and requires little
maintenance. The main components of HiSOC® systems are:
• HiSOC® units (one unit per treatment well)
• Two stage low -flow hydrogen regulator (gauge reading 0-100 PSI)
• Industrial grade hydrogen in cy linders (consumption: 2 cu ft/per day/per HiSOC®)
• Nitrogen gas supply and reatiIator for system start up, leak detection and purging
• Stainless steel tubing (0.250" OD)
• Conduit for tubing, well head valve boxes and related materials
• An above ground storage area (shelter or security cage for regulator & cylinders)
• A treatment well ventilation system
TRIGONENGINEERINGCONsuLTANTs, INC. E-2

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
Items supplied by inVentures Technologies per HiSOO include:
• HiSOO unit
• HiSOO tool for use when opening drain plug (1 per distribution header)
• Snoop Liquid Leak Detector (1 per distribution header)
• 1 filter
• 1 HiSOO repair kit: 1 HiSOC® flow -control valve, 1 stainless steel snap ring, 1 direction sheet
All system components should be leak tested and monitored for hydrogen gas.
DELIVERY OF OXYGEN WITH THE iSOC® SYSTEM
Following the treatment of the chlorinated solvents, the HiSOO units will be removed from the wells,
cleaned, and shipped to InVentures for modification to iSOC® units. Five of the iSOC® locations are the
same as locations proposed for HiSOC® units including monitoring wells MW-7, MW-10, MW 23D,
MW-24, and MW-43D. Five additional existing well locations (MW-16, MW-31, MW-32, MW; 40, and
M -41) will be modified with well vaults, tubing and wire leads, well caps, -oxygen regulators with
barbed hose fittings for purging the system with nitrogen, and an oxygen cylinder and casing. The iSOC®
units will be installed to drive the subsurface aerobic to treat petroleum hydrocarbons. The proposed
iSOC® installation locations are shown on Figure 10. The iSO0 units will diffuse oxygen into the
selected existing wells until petroleum hydrocarbons are reduced to acceptable levels within
groundwater at the site. To maximize the efficiency of this system, iSO0 units may be relocated. This
may require modification to additional wells in the future.
In an aerobic bioremediation application, the iSO0 supersaturates the treatment well with low decay
dissolved oxygen (DO), typically 40-200 PPM depending on the immersion depth of the iSOC® in
groundwater. A natural convection current and a designed release bubble from the top of the iSOC® fills
the well with uniform DO. The supersaturated DO curtain of water disperses around the well into the
adjacent groundwater forming a treatment zone and enhanced bioremediation removes target
contaminants. Placement of injection wells depends on site -specific conditions and treatment objectives
as described further below. Treatment well screens typically span the full thickness of the contaminated
groundwater zone. The iSOC® system is installed in a few hours to days depending on the number of
treatment wells. iSOC® units are easily moved from well to well to optimize performance and
remediation strategies.
TRIGON ENGINEERING CONSULTANTS, lNc. E-3

Mr. Peter Pozzo, NC DENR-DWQ August 18, 1007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 041-06-116
Experience in the field has shown that in each treatment well where an iSOC® is installed, high levels
dissolved oxygen levels of can easily be achieved, depending on the height of the water column in the
well. Each atmosphere of pressure allows for a maximum of 40 ppm of dissolved oxygen. Oxygen is
continuously infused into the aquifer over a period of several months to up to several years, as needed.
During this time, a large and continuous supply of oxygen is infused into the groundwater system to
provide significant enhanced degradation of hydrocarbons, including BTEX and MTBE/TBA. Oxygen is
infused from the iSOC® into the monitoring well at a typical rate of 15 cubic centimeters/minute.
An 600 system does not require electrical power, does not generate any noise and requires little
maintenance. The main components of iSO0 systems are:
• iSO0 units (one unit per treatment well)
• Two stage low -flow oxygen regulator with'/4" NPT female outlet (gauge reading 0-100 PSI)
• Industrial grade oxygen in cylinders (consumption: 1 cu ft/per day/per iSOC®)
• Polyurethane tubing (0.250" OD x 0.167" ID - SMC part # TIUB07) or (6mm OD x 4mm ID -
SMC part# TU0604) or equal)
• Conduit for tubing, well head valve boxes and related materials
• An above ground storage area (shed, trailer or security cage for regulator & cylinders) or
• A ground vault storage arrangement (regulator & cylinder storage at wellhead)
Items supplied by in Ventures Technologies per iSOC® include:
• iSO0 unit
• iSO0 tool for use when opening drain plug (1 per distribution header)
• Distribution header complete with regulator connector
• Bleed valve and iSOC® valve connections
• Snoop Liquid Leak Detector (1 per distribution header)
• 1 filter
• 2 black hose clamps used at iSOC® barb connections (1 spare)
• Nylon collar with stainless steel hose clamp used at distribution header barb connection
• 1 iSO0 repair kit: 1 iSOC® flow -control valve, 1 stainless steel snap ring, 2 plastic hose clamps,
1 direction sheet
The following photograph and schematic generally represent how the HiSOC®/iSOC® systems will be
installed at each of the monitoring well locations.
TR/GONENG/NEERING CONSULTANTS, INC. E-4

Mr. Peter Pozzo, NC DEAR-DWQ August 28, 2007
Gilbarco. 7300 West Friendly Avenue, Greensboro, .forth Carolina Trigon Project No. 042-06-216
Photograph of iSOCO with In -Well Oxygen System
24" Syware or Round
AsphalVConcrete Surface VVe1. Pox
- Minimum 3" of
Clear Stone/Gravel
2" Well c/w Cap ! I 1 D' PVC
i ��.i Tank Sleeve
Groundwater iSOCO Fitter
� N SOClUnit
iSOC2' Well Schematic
TRIGON ENGj?vEmNG CONSULTANTS, 1NC. E-5

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
ATTACHMENT F: MONITORING PLAN
Monitoring of the injection system will consist of quarterly groundwater sampling events. Each
monitoring event will consist of inspecting the injection system and sampling groundwater for volatile
organic compounds. Aquifer characteristics, such as static water level, temperature, pH, specific
conductivity, dissolved oxygen, and oxidation/reduction potential will be measured in the field at the
time samples are collected. Ten monitoring wells will be sampled quarterly for these parameters.
However, the number of sampling points, sampling locations, types of laboratory analysis, and frequency
of monitoring is likely to be modified during the course of the project to be able to collect appropriate
monitoring data. The monitoring wells to be sampled will include MW-7, MW-11, MW-13, MW-13D,
MW-14, MW-23D, MW-24, MW-25, MW42, and MW-45 during hydrogen injection. Monitoring wells
to be sampled during injection of oxygen will include MW-13, MW 13D, MW-14, MW-25, MW-28,
MW-32, MW-41, MW-42 and MW-45.
The results of the quarterly monitoring events will be reported to the Guilford County Environmental
Health Department and the UIC Program. The monitoring reports will include: current groundwater
monitoring data, a summary of remediation activities to date and recommendations for future
remediation activities; a historical summary of analytical results; details of the modification of the
existing monitoring wells; a groundwater potentiometric map; description of contaminant plume size and
location; predictive rate of contaminant transport; and an evaluation of the progress, performance, and
efficiency of the remediation process.
HYDROGEN
Following startup of the hydrogen infusion system, cylinder gas pressure will be monitored to verify
expected usage. Each HiSOC® unit uses approximately 2 cubic feet of hydrogen per day. Cylinders are
not always 100% full, and flow may vary slightly. Pressure settings on the regulator will be set per the
manufacturers specifications.
During each site visit the remaining cylinder pressure will be recorded along with HiSOCa regulator
pressure setting. The estimated number of days to cylinder replacement will be calculated based on gas
consumption since the last reading. HiSOC® water filters will be inspected at a minimum on a quarterly
TRtGONENGINEERLNG CONSULTANTS, INC. F-1

Mr. Peter Porro, NC DENR-DWQ August 28, 2007
Gilbarco, 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project No. 042-06-216
schedule and drained of accumulated water as necessary.
Maintenance of the HiSOC® and iSOC® units will include removing them from the wells once annually,
cleaning them with muriatic acid, replacing any corroded or worn parts, and re -installing them in the
wells.
OXYGEN
Following startup of the oxygen infusion system, groundwater dissolved oxygen (DO) concentrations in
the infusion wells will be monitored with a high range DO meter to assure target DO levels are reached.
DO in treatment wells should reach equilibrium within the first 24 hours. DO monitoring will then be
performed after one month of operation and thereafter quarterly along with the groundwater sampling
events. The dissolved oxygen concentration increases with immersion depth of the iSOC® infusion unit
below the water table. The unit should always sit as close to the bottom of the well as practical.
Head (feet)
1
10
16
25
50
DO Concentration (ppm)
40
53
60
70
100
Each iSOC® unit uses approximately 1 cubic foot of oxygen per day. Cylinders are not always 100% full,
and flow may vary slightly. Pressure settings on the regulator will be set per the manufacturers
specifications.
If low DO concentrations are recorded, it may be due to higher than expected groundwater flow or a large
oxygen demand. The regulator pressure can be increased to increase dissolved oxygen concentrations.
The gas usage will then increase and should be assessed for expected usage and tank change out
scheduling.
During each site visit the remaining cylinder pressure will be recorded along with iSOC® regulator
pressure setting. The estimated number of day to cylinder replacement will be calculated based on gas
consumption since the last reading. iSOC" water filters will be inspected at a minimum on a quarterly
schedule and drained of accumulated water as necessary.
TRIGON ENGINEERING CONSULTANTS, INC. F-2

Mr. Peter Pozzo, NC DENR-DWQ August 28, 2007
Gilbarco 7300 West Friendly Avenue, Greensboro, North Carolina Trigon Project Alo. 042-06-216
ATTACHMENT G: WELL DATA AND TABLES
TR/GON ENGINEERING CONSULTANTS, INC. G-1

Mr. Peter Pozzo, NCDENR UIC Program
7300 West Friendly Avenue. Greensboro, North Carolina
TABLE 1: MONITORING WELL CONSTRUCTION DATA
August 18, 1007
Tngon Project No. 041-06-116
Well ID
Date Completed
Total Depth
(feet TOC)
Screened Interval
(feet TOC)
TOC Elevation
(feet)
Bottom
Elevation (feet)
Date Water
Level Checked
Static Water
Level (feet TOC)
Groundwater
Elevation
MW-1
10/17/1995
31.0
11.0-31.0
A
---
---
---
-
MW-2
10/17/1995
30.0
10.0-30.0
A
---
---
---
---
MW-3
10/17/1995
30.0
10.0-30.0
A
-
---
---
MW-4
10/17/1995
30.0
10.0-30.0
A
---
---
---
MW-5
10/18/1995
30.0
10.0-30.0
A
---
---
---
---
MW-6
10/18/1995
34.0
19.0-34.0
A
---
---
---
MW-7(E)
11/12/1995
35.0
15.0-35.0
A
---
---
---
---
VEW-1
10/17/1995
55.0
50.0-55.0
A
-
--
VEW-2
11/8/1995
95.0
90.0-95.0
A
---
---
---
---
MW-7
3/17/1987
29.9
19.9-29.9
861.40
831.50
5/3/2007
7.77
853.63
MW-10
3/17/1987
33.6
23.6-33.6
859.25
825.65
ll/l/2006
8.68
850.57
MW-11
9/22/1987
25.1
24.1-25.1
859.26
834.16
ll/l/2006
13.73
845.53
MW-12
7/17/1987
16.8
11.8-16.8
851.50
834.70
5/3/2007
8.21
843.29
MW-12D
9/17/1987
27.0
24.0-27.0
851.06
824.06
ll/l/2006
8.49
842.57
MW-13
5/18/1988
24.2
19.2-24.2
861.29
837.09
ll/l/2006
14.14
847.15
MW-13D
5/18/1988
39.4
34.4-39.4
860.40
821.00
ll/l/2006
13.81
846.59
MW-14
5/17/1988
24.8
19.1-24.8
859.32
834.52
ll/1/2006
18.39
840.93
MW-14D
5/17/1988
41.0
35.8-41.0
859.26
818.26
ll/l/2006
19.68
839.58
MW-15
5/19/1988
25.2
15.2-25.2
857.71
832.51
ll/l/2006
13.60
844.11
MW-16
6/14/1989
35.2
20.2-35.2
863.60
828.40
5/3/2007
26.38
837.22
MW-17
6/24/1989
21.0
6.0-21.0
A
---
ll/l/2006
--
---
MW-23D
6/22/1989
57.1
52.1-57.1
861.04
803.94
5/3/2007
15.76
845.28
MW-24
6/21/1989
58.8
53.8-58.8
858.81
800.01
5/3/2007
19.72
839.09
MW-25
3/22/1993
168.9
163.9-168.9
861.47
692.57
ll/l/2006
23.61
837.86
MW-26
1/16/1995
23.9
8.9-23.9
A
---
ll/l/2006
---
-
MW-27
1/16/1995
44.0
39.044.0
862.74
818.74
ll/l/2006
13.32
849.42
MW-28
1/16/1995
23.8
8.8-23.8
861.54
837.74
12/14/2006
8.79
852.75
MW-29
5/29/1995
18.8
3.8-18.8
861.18
842.38
ll/l/2006
4.84
856.34
MW-30
5/30/1995
73.4
68.4-73.4
862.28
788.88
ll/l/2006
13.13
849.15
MW-31
5/31/1995
19.0
4.0-19.0
861.73
842.73
ll/l/2006
9.98
851.75
MW-32
6/1/1995
19.6
4.6-19.6
861.76
842.16
5/3/2007
8.02
853.74
MW-33
8/21/1995
21.0
6.0-21.0
861.77
840.77
ll/l/2006
14.11
847.66
MW-34
8/21/1995
21.0
6.0-21.0
860.45
839.45
5/3/2007
17.41
843.04
MW40
2/14/1996
29.7
4.7-29.7
860.62
830.92
ll/l/2006
10.26
850.36
MW41
2/14/1996
20.3
5.3-20.3
860.52
840.22
5/3/2007
6.79
853.73
MW-42
1/3/2006
35.0
30.0-35.0
865.32
830.32
ll/l/2006
29.96
835.36
MW-43(D)
1/4/2006
53.0
48.0-53.0
865.47
812.47
5/3/2007
28.31
837.16
MW44
4/5/2007
28.5
13.5-28.5
NM
---
5/3/2007
16.16
---
RW-1
6/13/1989
27.5
16.5-27.5
NM
---
ll/l/2006
16.10
---
RW-2
6/19/1989
25.5
8.6-25.5
NM
---
ll/l/2006
13.30
---
RW-3
2/13/1997
31.0
10.2-31.0
NM
11/1/2006
17.60
---
RW 4
2/15/1996
70.0
10.0-70.0
NM
---
ll/l/2006
10.91
---
Notes:
feet TOC = feet below top of well casing
NM = Not measured
A = Well has been abandoned
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Poso, NCDENR UIC Program
7300 West Friendly Awnue, Greensboro, North Carolina
TABLE 2: SUMMARY OF GROUNDWATER SAMPLE RESULTS
August 28, 2007
Trigon Project No. 042-06-216
Parameter
NCGS
I Anal dcal Results
Sam le ID
2L
Standard
I MW-7
MW-10
MW-11
MW-12
MW-12D
MW-13
MW-13D
MW-14
MW-14D
MW-15
MW-16
MW-23D
MW-24
MW-25
MW-27
Collection Date
1 08/25/06 12/14/06
08/24/06
08/24/06
08/24/06
08/24/06
08/24/06
08/24/06
08/24/06
08/24/06
08/24/06
08/25/06
08/24/06
08/24/06
08/25/06
11/01/06
Volatile Organic Compounds by EPA Method 6011602 (pg/l)
Benzene
1
1.7
4.1
8.1
BDL
BDL
BDL
BDL
BDL
BDL
1.3
BDL
BDL
1.8
660
BDL
6.2
Dichlorodifluoromethane
1400
20
54
1.4
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2.4
BDL
BDL
BDL
1,1 Dichloroethane
70
BDL
15
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDI.
BDL
6.4
BDL
BDL
1,1 Dichloroethene
7
14
570
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1.4
BDL
2.9
BDL
15
BDL
BDL
cis - 12 Dichloroethene
70
2,000
2,100
3
5.2
BDL
BDL
110
30
BDL
17
48
31
340
770
51
BDL
Trans-l2-Dichloroethene
100
1.5
5.1
BDL
BDL
BDL
BDL
1.1
BDL
BDL
BDL
BDL
BDL
BDL
1.2
BDL
BDL
Diisopropyl ether
70
3.3
BDL
4.3
BDL
BDL
BDL
BDL
BDL
BDL
6.4
BDL
BDL
9.1
160
4.3
BDL
Eth]benzene
550
370
1,300
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
38
MTBE
200
11
BDL
360
4.4
BDL
BDL
5.4
19
BDL
2.4
8
BDL
310
78
1.8
BDL
Naphthalene
21
82
440
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
5.6
BDL
16
Toluene
1,000
23
39
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
4.8
BDL
2.4
Tetrachloroethene
0.7
BDL
3.6
BDL
4.9
BDL
BDL
BDL
BDL
46
47
5.5
36
BDL
2,200
20
BDL
Trichloroethene
2.8
BDL
4
BDL
2.5
BDL
BDL
2.9
BDL
BDL
2
5
7.4
1.1
84
4.8
BDL
Trichlorofluoromethane
2100
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
16
BDL
BDL
111-Trichloroethane
200
14
13
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDI.
BDL
5.5
BDL
BDL
Vinyl Chloride
0.015
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1.3
BDL
BDL
BDL
BDL
1.9
BDL
BDL
BDL
Total X lens
530
380
1,660
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
10.4
BDL
3.1
Total VOCs
----
2,921
6,208
376.8
17
----
----
119.4
50.3
46
77.5
66.5
77.3
666.3
4,017
81.9
65.7
Parameter
NCGS
I Analytical Results
Sample ID
2L
Standard
I MW-28
MW-29
MW-30
MW-31
MW-32
MW-33
MW-34
MW-40
MW-41
MW-42
MW-43D
MW-44
Collection Date
1 08/25/06 12/14/06
08/25/06
08/25/06
11/01/06
08/25/06 11/01/06 12/14/06
08/25/06
08/25/06
11/01/06
08/24.!06
08/25/06
08/25/06
04/11/07
Volatile Organic Compounds by EPA Method 6011602 (pgA)
Benzene
1
17,
100
BDL
23
BDL
1400
1400
1500
BDL
BDL
250
3100
BDL
2
BDL
Dichlorodifluoromethane
1,400
BI 1:
BDL
1.4
16
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
13 Dichloroethane
70
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2.3
BDL
BDL
1.5
4.5
BDL
1,1 Dichloroethene
7
BDL
BDL
BDL
2.5
BDL
BDL
BDL
BDL
BDL
4.8
BDL
BDL
3.5
21
BDL
cis - 1,2 Dichloroethene
70
BDL
BDL
38
23
BDL
BDL
BDL
BDL
5.7
24
BDL
BDL
4.7
75
BDL
Trans- l2-Dichloroethene
100
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Diisopropyl ether
70
BDL
BDL
BDL
13
BDL
32
BDL
BDL
BDL
BDL
BDL
6.4
BDL
34
BDL
Eth lbenzene
550
2,500
2,500
BDL
2.6
1,700
190
340
1,700
BDL
BDL
280
1000
BDL
BDL
BDL
MTBE
200
BDL
BDL
BDL
1,500
BDL
15,000
20,000
16,000
BDL
BDL
BDL
BDL
BDL
18
BDL
Naphthalene
21
800
940
BDL
BDL
720
160
BDL
1,100
BDL
BDL
130
16
BDL
BDL
BDL
Toluene
1,000
56
BDL
BDL
BDL
BDL
280
320
3,700
BDL
BDL
230
3,000
BDL
BDL
BDL
Tetrachloroethene
0.7
BDL
BDL
5
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
27
280
BDL
Ethlbenzene
29
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Toluene
1000
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Total X lens
530
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Vinyl Chloride
0.015
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Trichloroethene
2.8
BDL
BDL
2.2
BDL
BDL
BDL
BDI.
BDL
BDL
59
BDL
BDL
BDL
8.3
2.1
Trichlorofluoromethane
2100
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2.2
BDL
111-Trichloroethane
200
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Vinyl Chloride
0.015
BDL
BDL
BDL
16
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
Total X lens
530
1200
530
BDL
2
390
600
900
8,000
BDL
BDL
552
2.900
BDL
BDL
BDL
Total VOCs
4,556
4,070
46.6
1,598
2,810
17,662
22,960
32.000
5.7
90.1
1442
10 022
36.7
445
BDL
Notes:
VOCs = Volatile Organic Compounds
NCGS = North Carolina Groundwater Standards
BDL = Below Detection Limits
ug/I = Micrograms per liter, analogous to parts per billion
BOLD = Concentration exceeds the 2L Groundwater Quality Standards
MTBE = Methyl-tert-butyl ether
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Pozzo, NCDENR UIC Program
7300 West Friendly Avenue, Greensboro, North Carolina
August 28, 2007
Trigon Project No. 042-06-216
TABLE 3: SUMMARY OF GROUNDWATER SAMPLE RESULTS (RECOVERY WELLS)
Parameter
NCGS
Analytic I Results
Sample ID
2L
Stanaard
RW-1
RW-2
RW-3
RW-4
Collection Date
08/25/06
08/25/06
08/25/06
08/25/06
Volatile Organic Compounds by EPA Method 6011602 (ug/l)
Benzene
1
BDL
BDL
48
63
Dichlorodifluoromethane
1,400
BDL
BDL
33
84
1,1 Dichloroethane
700
BDL
BDL
3.8
5.6
1,1 Dichloroethene
7
BDL
BDL
6.2
8.3
cis - 1,2 Dichloroethene
70
BDL
380
220
180
Diisopropyl ether
70
BDL
BDL
1.2
4.9
Eth lbenzene
29
BDL
BDL
7.7
58
MTBE
200
BDL
BDL
74
250
Naphthalene
21
BDL
BDL
35
24
Tetrachloroethene
0.7
BDL
22
14
3.3
Trichloroethene
2.8
BDL
45
7.3
3.1
1,1,1 Trichloroethane
200
BDL
BDL
9.1
BDL
Toluene
I A00
BDL
BDL
BDL
36
Vinyl Chloride
0.015
BDL
BDL
8.5
60
Total X lens
530
BDL
BDL
4.9
68
Total VOCs
----
----
447
472.7
848.2
Notes:
VOCs - Volatile Organic Compounds
NCGS - North Carolina Groundwater Standards
BDL - Below Detection Limits
ug/1- Micrograms per liter, analogous to parts per billion
BOLD - Concentration exceeds the 2L Groundwater Quality Standards
MTBE - Methyl-tert-butyl ether
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Pouo, NCDENR UIC Program
7300 West Friendly Avenue, Greensboro, North Carolina
TABLE 4: HISTORICAL SUMMARY OF GROUNDWATER SAMPLE RESULTS
August 28, 2007
Tngon Project No. 042-06-216
Sample ID
Parameter
Collection Date
Benzene
Toluene
Ethylbenzene
Total Xylenes
Trichloroethene
1,1,1 Trchloroethene
Tetrachloroethene
1,1 Dichloroethene
trans 1,2
Dichloroethane
1,2 Dichloroethene
Trichlorofluoromethane
1,1 Dichloroethene
MTBE
Dusopropyl ether
cis 1,2
Dichloroethene
Naphthalene
Dichlorodi
fluoromethane
Vinyl Chloride
Total VOCs
NCGS 2L St&
1
1,000
550
530
2.8
200
0.7
7
100
0.39
2,100
70
200
70
70
21
1,400
0,015
MW-7
01/14/92
480
3,900
2,100
7,100
360
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
13,940
09/27/90
650
5,300
1,500
5,700
190
59
790
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
14,189
03/11/98
468
8,920
2,200
8,990
BDL
238
BDL
354
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
21,170
05/25/99
253
2,280
2,290
10,800
BDL
347
BDL
723
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
16,693
04/27/03
BDL
220
2,400
5,700
BDL
88
BDL
BDL
BDL
BDL
BDL
BDL
BDL
60
BDL
BDL
BDL
BDL
8,468
06/30/04
BDL
110
1,800
3,800
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2,300
520
BDL
BDL
8,530
08/16/05
BDL
BDL
1,600
3,020
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2,100
520
BDL
BDL
7,240
08/25/06
1.7
23
370
380
BDL
14
BDL
14
1.5
BDL
BDL
BDL
11
3.3
2,000
82
20
BDL
2,921
12/14/06
4.1
39
1,300
1,660
4
13
3.6
570
5.1
BDL
BDL
15
BDL
BDL
2,100
440
54
BDL
6,208
MW-8 (abandoned)
05/15/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
01/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/27/90
BDL
BDL
BDL
1
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1
MW-9 (abandoned)
05/15/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL BDL
BDL
BDL
BDL
BDL
0
01/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL BDL
BDL
BDL
BDL
BDL
0
09/27/90
2
BDL
BDL
BDL
2
BDL
10
BDL
BDL
BDL
BDL
BDL
BDL BDL
BDL
BDL
BDL
BDL
14
NM-10
01/14/92
2,900
BDL
BDL
120
78
BDL
BDL
120
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3,218
09/27/90
2,900
66
BDL
670
140
140
76
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3,992
03/11/98
234
BDL
BDL
BDL
BDL
BDL
BDL
13.9
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
248
05/26/99
36
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
36
10/10/02
220
8.5
16
71
2.3
7.3
5.9
4.4
BDL
BDL
BDL
BDL
2,200
16
BDL
BDL
BDL
BDL
2,551
04/22/03
47
BDL
BDL
BDL
L3
2.6
3.2
BDL
BDL
BDL
BDL
BDL
1,100
2.9
BDL
BDL
BDL
BDL
1,157
06/30/04
22
BDL
2.8
5.8
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
770
2-8
8.1
BDL
BDL
BDL
812
08/16/05
43
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
6811
BDL
BDL
BDL
BDL
BDL
723
08/24/06
8.1
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1 360
1 4.3
3
BDL
1.4
BDL
377
MW-11
06/30/04
BDL
BDL
BDL
BDL
3
BDL 2.1
BDL
BDL
BDL
BDL
BDL
4.1
BDL
1.4
BDL
BDL
BDL
9
08/15/05
BDL
BDL
BDL
BDL
3.6
BDL 5
BDL
BDL
BDL
BDL
BDL
2.2
BDL
9.7
BDL
BDL
BDL
21
08/24/06
BDL
BDL
BDL
BDL
2.5
BDL 4.9
BDL
BDL
BDL
BDL
BDL
4.4
BDL
5.2
BDL
BDL
BDL
17
MW-12
01/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/27/90
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
05/26/99
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
08/24/06
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
MW-12D
01/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/27/90
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
05/26/99
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
13DL
BDL
BDL
BDL
BDL
BDL
BDL
0
08/24/06
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
MW-13
05/15/92
BDL
BDL
BDL
BDL
20
BDL
130
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
150
01/14/92
BDL
BDL
BDL
BDL
36
BDL
130
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
166
09/26/90
BDL
BDL
BDL
BDL
BDL
BDL
2
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2
03/11/98
BDL
BDL
BDL
BDL
4.7
BDL
2.5
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
7
05/26/99
BDL
BDL
BDL
BDL
15
BDL
4.2
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
19
06/30/04
BDL
BDL
BDL
BDL
6.5
BDL
BDL
BDL
BDL
BDL
BDL
BDL
13
BDL
140
BDL
BDL
BDL
160
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
110
BDL
BDL
BDL
110
08/24/06
BDL
BDL
BDL
BDL
2.9
BDL
BDL
BDL
1.1
BDL
BDL
BDL
5.4
BDL
110
BDL
BDL
BDL
119
Notes:
AO units measured in ug/L
BDL - Below Detection Limits
NCGS 2L Std. - North Carolina Groundwater Standard
BOLD - Concentration exceeds the 2L Groundwater Quality Standard
MTBE - Methyl -ten butyl ether
Page 1
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Poz:o, NCDENR UIC Program
7300 West Friendly Avenue, Greensboro, North Carolina
TABLE 4: HISTORICAL SUMMARY OF GROUNDWATER SAMPLE RESULTS
August 28, 2007
Trigon Project No. 042-06-216
Sample ID
Parameter
Collection Date
Benzene
Toluene
Ethylbenzene
Total Xylenes
Trichloroethene
1, 1, 1 Trichloroethane
Tetrachloroethene
1,1Dichloroethene
trans 1,2
Dichloroethane
1,2Dichloroethane
Trichlorofluoromethane
1,1Dichloroethane
MTBE
Dusopropylether
cis 1,2
Dichloroethene
Naphthalene
Dichlorodifluoro
methane
V'mylChloride
TotaIVOCs
NCGS 2L Std.
1
1,000
550
530
2.8
200
0.7
7
100
0.39
2,100
70
200
70
70
21
1,400
0.015
MW-13D
06/30/04
Ll
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
26
1.1
18
BDL
BDL
1.5
48
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
20
1.3
37
BDL
BDL
1.4
60
08/24/06
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
19
BDL
30
BDL
BDL
1.3
50
MW-14
O1/14/92
BDL
60
BDL
100
BDL
100
1,400
BDL
BDL
180
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1,840
09/26/90
BDL
BDL
BDL
BDL
BDL
BDL
1,300
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1,300
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
80
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
80
05/25/99
BDL
BDL
BDL
BDL
BDL
BDL
67
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
67
04/22/03
1.1
L7
BDL
L9
BDL
BDL
110
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
115
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
80
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
80
08/16/05
BDL
BDL
BDL
BDL
BDL
BDL
58
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
58
L46
08/24/06
BDL
BDL
BDL
BDL
BDL
BDL
46
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
MW-14D
09/09/92
220
BDL
BDL
BDL
BDL
13
210
23
BDL
BDL
10
BDL
BDL
BDL
BDL
BDL
BDL
BDL
476
05/15/92
4.7
BDL
BDL
BDL
BDL
BDL
56
2.1
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
63
O1/14/92
65
3
BDL
BDL
BDL
BDL
200
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
268
09/27/90
45
1
BDL
5
3
20
110
58
BDL
BDL
1
5
BDL
BDL
BDL
BDL
BDL
BDL
248
03/11/98
5.6
BDL
BDL
BDL
BDL
BDL
35.4
10.6
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
52
05/25/99
67
BDL
BDL
BDL
BDL
BDL
201
25
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
293
10/10/02
8.3
BDL
BDL
BDL
2.9
BDL
79
4
BDL
BDL
BDL
4.2
11
29
BDL
BDL
BDL
BDL
138
04/22/03
BDL
BDL
BDL
BDL
BDL
BDL
40
1.2
BDL
BDL
BDL
BDL
BDL
1.9
BDL
BDL
BDL
BDL
43
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
29
3.5
BDL
BDL
BDL
2.2
3.3
BDL
3.0
BDL
BDL
BDL
38
O9/16/05
5.4
BDL
BDL
BDL
1.8
BDL
55
3.3
BDL
BDL
BDL
BDL
3.2
7.3
15
BDL
BDL
BDL
91
O9124/06
1.3
BDL
BDL
BDL
2
BDL
47
1.4
BDL
BDL
BDL
BDL
2.4
6.4
17
BDL
BDL
BDL
78
MW-15
O1/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/27/90
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
05/25/99
BDL
BDL
BDL
BDL
3
BDL
4.9
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
8
10/10/02
BDL
BDL
BDL
BDL
7.8
BDL
13
BDL
BDL
BDL
2.6
1.4
29
BDL
BDL
BDL
BDL
BDL
54
04/22/03
BDL
BDL
BDL
BDL
5
BDL
11
BDL
BDL
BDL
BDL
14
17
BDL
BDL
BDL
BDL
BDL
34
06/30/04
BDL
BDL
BDL
BDL
3.9
BDL
7.5
BDL
BDL
BDL
BDL
BDL
18
BDL
86
BDL
BDL
BDL
115
08/16/05
BDL
BDL
BDL
BDL
2.3
BDL
6.8
BDL
BDL
BDL
BDL
BDL
15
BDL
47
BDL
BDL
BDL
71
O8/24/06
BDL
BDL
BDL
BDL
5
BDL
5.5
BDL
BDL
BDL
BDL
BDL
8
BDL
48
BDL
BDL
BDL
67
MW-16
O1/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/26/90
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
1.9
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2
06/02/99
BDL
BDL
BDL
BDL
BDL
BDL
2.4
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2
10/10/02
BDL
BDL
BDL
BDL
3.8
BDL
22
1.8
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
28
04/22/03
BDL
BDL
BDL
BDL
8.6
BDL
46
3.6
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
58
06/30/04
BDL
BDL
BDL
BDL
7.6
BDL
31
2.7
BDL
BDL
BDL
1
BDL
BDL
24
BDL
BDL
BDL
66
O8/15/05
BDL
BDL
BDL
BDL
4.4
BDL
30
L8
BDL
BDL
BDL
BDL
BDL
17
BDL
BDL
BDL
BDL
53
08/25/06
BDL
BDL
BDL
BDL
7.4
BDL
36
2.9
BDL
BDL
BDL
BDL
BDL
BDL
31
BDL
BDL
BDL
77
MW-17(abandoned 01/03/06)
O1/14192
BDL
BDL
BDL
BDL
3
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3
09/26/90
BDL
BDL
BDL
BDL
BDL
BDL
I
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
1
03/11/98
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
06/02/99
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
17
BDL
BDL
BDL
BDL
BDL
17
Notes:
All units measured in ug/L
BDL - Below Detection Limits
NCGS 2L Sid, - North Carolina Groundwater Standard
BOLD - Concentration exceeds the 2L Groundwater Quality Standard
MTBE - Methyl-tert butyl ether
Page 2
TRIGONENGINEERING CONSULTANTS, INC.

Mr. Peter Pozen, NCDENR UIC Program
7300 West Friendly A rerme, Greensboro, .North Carolina
TABLE 4: HISTORICAL SUMMARY OF GROUNDWATER SAMPLE RESULTS
August 28, 2007
Trrgon Project No. 042-06-216
Sample ID
Parameter
Collection Date
Benzene
Toluene
Ethylbenzene
Total Xylenes
Trichloroethene
1,1,1 Trichloroethane
Tetrachloroethene
1,1 Dichloroethene
trans 1,2
Dichloroethane
1,2 Dichloroethane
Trichloro8uoromethane
l,I Dichloroethane
DTTBE
Dusopropyl ether
cis 1,2
Dichloroethene
Naphthalene
DichlorodiFluoro
methane
Vinyl Chloride
Total VOCs
NCGS 2L Std.
1
1,000
550
530
2.8
200
M
7
100
0.38
2,100
70
200
70
70
21
1,400 1
0.015
MW-23D
09/09/92
6.3
BDL
BDL
BDL
6.3
BDL
1.8
5.4
BDL
2
BDL
6.5
BDL
BDL
BDL
BDL
BDL
BDL
28
05/15/92
45
BDL
BDL
BDL
2.2
BDL
BDL
BDL
BDL
BDL
BDL
53
BDL
BDL
BDL
BDL
BDL
BDL
53
01/14/92
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
09/27/90
1
BDL
BDL
BDL
2
BDL
BDL
BDL
BDL
5
BDL
5
BDL
BDL
BDL
BDL
BDL
BDL
13
03/11/98
7.1
37
BDL
BDL
2.5
4
2.5
14
BDL
BDL
BDL
29
BDL
BDL
BDL
BDL
BDL
BDL
24
05/26/99
3.1
BDL
BDL
BDL
4.1
BDL
BDL
2.4
BDL
2.6
10
57
BDL
BDL
BDL
BDL
BDL
BDL
28
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
500
12
200
BDL
BDL
BDL
712
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
310
BDL
280
BDL
BDL
BDL
590
08/24/06
1.8
BDL
BDL
BDL
1A
BDL
BDL
BDL
BDL
BDL
BDL
BDL
310
9-1
340
BDL
2.4
1.9
666
MW-24
09/09/92
2,500
150
BDL
150
BDL
100
2,700
BDL
BDL
BDL
130
BDL
BDL
BDL
BDL
BDL
BDL
BDL
5,730
05/15/92
1,800
180
BDL
BDL
23
BDL
1,400
4.9
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3,410
01/14/92
1,800
260
BDL
340
110
80
3,800
200
BDL
56
190
BDL
BDL
BDL
BDL
BDL
BDL
BDL
6,836
09/27/90
1,500
80
BDL
80
28
BDL
630
60
BDL
BDL
30
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2,408
03/11/98
1,920
BDL
BDL
BDL
BDL
BDL
1,230
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3,150
05/25/99
1,510
BDL
BDL
BDL
BDL
BDL
637
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2,147
10/10/02
1,700
16
1.4
27
68
4.9
2,000
31
BDL
2.5
41
11
180
5M
BDL
BDL
BDL
BDL
4,613
04/22/03
500
64
BDL
6 3
24
1.8
1 640
17
BDL
BDL
3.3
6.4 1
81
180
BDL
BDL
BDL
BDL
1,466
06/30/04
280
BDL
BDL
BDL
BDL
BDL
870
BDL
BDL
BDL
BDL
BDL
74
200
370
BDL
BDL
BDL
1,794
08/16/05
420
BDL
BDL
BDL
62
BDL
1,300
BDL
BDL
BDL
BDL
BDL
69
170
570
BDL
BDL
BDL
2,191
08/24/06
660
4.8
BDL
10.4
84
5.5
2,200
15
L2
1.2
16
6-4
78
160
770
5.6
BDL
BDL
4,018
MW-25
03/11/98
BDL
BDL
BDL
BDL
3.5
BDL
8.9
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
12
05/26/99
BDL
BDL
BDL
BDL
3.6
BDL
10
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
14
06/30/04
BDL
BDL
BDL
BDL
3.5
BDL
8.1
BDL
BDL
BDL
BDL
BDL
BDL
4.4
9.9
BDL
BDL
BDL
26
08/16/05
BDL
BDL
BDL
BDL
3.9
BDL
17
BDL
BDL
BDL
BDL
BDL
3.6
BDL
31
BDL
BDL
BDL
56
08/25/06
BDL
BDL
BDL
BDL
4.8
BDL
20
BDL
BDL
BDL
BDL
BDL
1.8
43
51
BDL
BDL
BDL
82
MW-26 (abandoned 01/03/06)
07/01/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
NM-27
10/10/02
2.3
2
47
18
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2.3
BDL
BDL
BDL
BDL
BDL
72
07/01/04
5.4
2.7
34
79
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
I
BDL
BDL
17
BDL
BDL
78
08/16/05
12
4A
180
34
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
3.5
BDL
BDL
30
BDL
BDL
264
11/01/06
6.2
2A
38
31
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
16
BDL
BDL
65.7
MW-28
10/10/02
10
2.2
45
22.5
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2.3
BDL
BDL
BDL
BDL
82
07/01/04
95
51
1,500
1,065
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
480
BDL
BDL
3,191
08/15/05
210
78
2,300
750
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
740
BDL
BDL
4,078
08/25/06
170
56
2,500
1,200
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
S00
BDL
BDL
4,726
12/14/06
100
BDL
2,500
530
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
940
BDL
BDL
4,070
NW-29
07/01/04
BDL
BDL
21
BDL
BDL
BDL
23
BDL
BDL
BDL
BDL
BDL
BDL
BDL
280
BDL
BDL
BDL
324
08/15/05
BDL
BDL
BDL
BDL
4.2
BDL
39
BDL
BDL
BDL
BDL
BDL
BDL
BDL
29
BDL
BDL
BDL
72
08/25/06
BDL
BDL
BDL
BDL
2.2
BDL
5
BDL
BDL
BDL
BDL
BDL
BDL
BDL
38
BDL
1.4
BDL
47
MW-30
07/01/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
2,200
BDL
BDL
BDL
BDL
BDL
2,200
08/16/05
74
BDL
58
BDL
BDL
BDL
BDL
43
BDL
BDL
BDL
BDL
510
BDL
200
BDL
67
77
1,029
08/25/06
23
BDL
2.6
2
BDL
BDL
BDL
2.5
BDL
BDL
BDL
BDL
1,500
13
23
BDL
16
16
1,598
MW-31
10/10/02
BDL
320
2,600
7,900
BDL
BDL
BDL
BDL
BDL
BDL
BDL-1
BDL
BDL
BDL
BDL
BDL
BDL
BDL
10,820
04/22/03
BDL
310
1,800
4,600
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
6,710
07/01/04
18
84
590
1,360
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
53
400
BDL
BDL
2,505
08/15/05
BDL
67
1,100
1,490
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
48
750
BDL
BDL
3,435
11/01/06
BDL
BDL
1,700
390
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
720
BDL
BDL
2,810
MW-32
07/01/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
290
BDL
BDL
BDL
BDL
BDL
290
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
ISO
BDL
BDL
BDL
BDL
BDL
180
08/25/06
1,400
280
190
600
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
15,000
32
BDL
160
BDL
BDL
17,662
11/01/06
1,400
320
340
900
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
20,000
BDL
BDL
BDL
BDL
BDL
22,960
12/14/06
1,500
3,700
1,700
8,000
1 BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
16,000
BDL
BDL
1,100
BDL
BDL
32,000
Notes:
All units measured in ug/L
BDL - Below Detection Limits
NCGS 2L Std. - North Carolina Groundwater Standard
BOLD - Concentration exceeds the 2L Groundwater Quality Standard
MTBE - Methyl-tert butyl ether
Page 3
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Pozzo, NCDENR UIC Progrmn
7300 West Friendly A venue, Greensboro, North Carolina
TABLE 4: HISTORICAL SUMMARY OF GROUNDWATER SAMPLE RESULTS
August 28, 2007
Tngon Project No. 042-06-216
Sample ID
Parameter
Collection Date
Benzene
Toluene
Ethylbenzene
Total Xylenes
Trichloroethene
1,1,1 Trichloroethane
Tetrachloroethene
1,1 Dichloroethene
trans 1,2
Dichloroethane
1,2 Dichloroethane
Trichlorofluoromethane 1,1 Dichloroethane
MTBE
Dusopropyl ether
cis 1,2
Dichloroethene
Naphthalene
Dichlorodifluoro
methane
Vinyl Chloride
Total VOCs
NCGS 2L Std.
1
1,000
550
530
2.8
200
0.7
7
100
0.38
2,100 70
200
70
70
21
1,400
0.015
MW-33
10/10/02
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
0
06/30/04
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
16
BDL
BDL
BDL
2
08/15/05
BDL
BDL
BDL
BDL
BDL
BDL
BDL
FiDI
BDL
BDL
BDL
BDL
BDL
BDL
56
BDL
BDL
BDL
6
08/25/06
BDL
BDL
BDL
BDL
BDL
BDL
BDL
UUL
BDL
BDL
BDL
BDL
BDL
BDL
5.7
BDL
BDL
BDL
6
MW-34
04/22/03
BDL
BDL
BDL
BDL
I00
BDL
BDL
15
BDL
BDL
BDL
T2
BDL
BDL
BDL
BDL
BDL
BDL
122
07/01/04
BDL
BDL
BDL
BDL
130
BDL
BDL
6.3
BDL
BDL
BDL
7.4
BDL
BDL
63
BDL
BDL
BDL
207
08/16/05
BDL
BDL
BDL
BDL
90
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
37
BDL
BDL
BDL
127
08/25/06
BDL
BDL
BDL
BDL
59
BDL
BDL
4.8
BDL
BDL
BDL
2.3
BDL
BDL
24
BDL
BDL
BDL
90
MW-40
11/01/06 250 230 280 552 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL 130 BDL BDL 1,442
MW-41
04/22/03
7,200
6,600
2,400
10,800
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
27,000
07/08/04
7,000
6,600
2,600
13,300
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
520
BDL
770
BDL
BDL
30,790
08/16/05
5,400
4,900
2,500
9,700
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
230
BDL
780
BDL
BDL
23,510
08/24/06
3,100
3,000
1,000
2,900
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
BDL
6.4
BDL
16
BDL
BDL
10,022
MW-42
01/10/06
BDL
BDL
BDL
BDL
BDL
BDL
36.0
6.1
BDL
BDL
BDL
16
BDL
BDL
75
3.2
BDL
BDL
54
08/25/06
BDL
BDL
BDL
BDL
BDL
BDL
27.0
3 5
BDL
BDL
BDL
L5
BDL
BDL
4.7
BDL
BDL
BDL
37
MW-43D
01/10/06 4.9 BDL BDL BDL 12.0 BDL 390 42.0 BDL BDL 57 6.8 360 68.0 1l0 BDL BDL BDL 675
MW-44
04/11/07 BDL BDL BDL BDL 2.1 BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL BDL
Notes:
All units measured in ug/L
-- No Standard
BDL - Below Detection Limits
NCGS 2L Std. - North Carolina Groundwater Standard
BOLD - Concentration exceeds the 2L Groundwater Quality Standard
MTBE - Methyl-tert butyl ether
Page 4
TRIGON ENGINFERING CONSULTANTS, INC.

Mr. Peter Pozzo, NCDENR UIC Program
7300 West Friendly Avenue, Greensboro, North Carolina
TABLE 5: AQUIFER CHARACTERISTICS FIELD ANALYSIS SUMMARY
August 28, 2007
Trigon Project No. 042-06-216
Monitoring Well
Sample
Date
Temp
(°C)
pH
Conductivity
(mS/cm)
Dissolved
Oxygen (mg/L)
Redox
(mV)
Preferred
Conditions
> 200C
5<pH<9
---
<0.5 mg/L
<50 mV
MW-7
05/03/07
16.26
6.82
0.353
4.56
-64.6
MW-12
05/03/07
15.58
5.78
0.146
5.26
-5.6
MW-16
05/03/07
15.02
6.87
0.305
5.98
-39
MW-23D
05/03/07
19.54
7.31
0.904
3.79
-206.7
MW-24
05/03/07
15.87
7.22
0.525
2.61
-168.3
MW-32
05/03/07
16.90
6.94
1.246
5.73
-105.5
MW-34
05/03/07
18.24
6.31
0.370
4.11
78.0
MW-41
05/03/07
15.86
6.39
0.701
4.47
-121.2
MW-43D
1 05/03/07
1 14.55
1 6.94
0.333
3.65
-18.1
MW-44
1 05/03/07
1 22.06
1 6.86
0.438
5.02
-119.5
Redox = oxidation-reduction potential
°C = degrees Celsius
mS/cm = millisiemens per centimeter
mg/l = milligrams per liter, analogous to parts per million
my = millivolts
Note: Conductivity is measured for consistency in groundwater sample collection.
TRIGON ENGINEERING CONSULTANTS, INC.

Mr. Peter Pozzo, NCDENR UIC Program
7300 West Friendly Avenue, Greensboro, North Carolina
TABLE 6: NATURAL ATTENUATION LABORATORY ANALYSIS SUMMARY
August 28, 2007
Trlgon Project No. 042-06-216
Monitoring Well
Sample
Date
Nitrate
(mg/L)
Sulfate
(mg/L)
BOD, 5 Day
(mg/L)
COD
(mg/L)
Methane
(mg/L)
Ethane (mg/L)
Ethene (mg/L)
MW-7
05/03/07
<0.10
<5.0
4.0
49.0
0.209
<0.020
<0.020
MW-12
05/03/07
0.71
11.0
<2.0
18
<0.010
<0.020
<0.020
MW-16
05/03/07
0.28
13.0
<2.0
34.0
<0.010
<0.020
<0.020
MW-23D
05/03/07
<0.10
8.8
13.0
66.0
0.236
<0.020
<0.020
MW-24
05/03/07
<0.10
17.0
4.0
37.0
0.0383
<0.020
<0.020
MW-32
05/03/07
<0.10
<5.0
29.0
210
0.717
<0.020
<0.020
MW-34
05/03/07
0.76
22.0
9.0
34.0
<0.010
<0.020
<0.020
MW-41
05/03/07
<0.10
<5.0
5.0
85.0
0.0305
<0.020
<0.020
MW-43D
05/03/07
0.52
14.0
5.0
25.0
<0.010
<0.020
<0.020
MW-44
05/03/07
<0.10
33.0
<2.0
46.0
<0.010
<0.020
<0.020
BOD = Biochemical Oxygen Demand
COD = Chemical Oxygen Demand
mg/L = milligrams per liter, analogous to parts per million
mS/cm = millisiemens per centimeter
mg/l = milligrams per liter, analogous to parts per million
mV = millivolts
Note: Conductivity is measured for consistency in groundwater sample collection.
TRIGON ENGINEERING CONSULTANTS, INC.

Site
i».rl

I
/
/
/
/ 4-
SW-02
iA
K' .
/ Myy_51 I$MW-02
- J-
F7
r
I
I
I r
I
I
I
>I
rt
0 I Z
O Z
DI Of
Y
m
cI a
0
OLD FRIENDLY AVENUE
1W46 $ MW48
rrr,r+++r++r+r+r++ryr
f
f I2
W FRIENDLY AVENUE
INJECTION WELL LOCATION
MW-14
MONITORING WELL LOCATION
Q RW3
RECOVERY WELL LOCATION
1
PROPERTY BOUNDARY
ew
SURFACE WATER LOCATION

c�E,cwa1
��Inrs2
MW-50
MW 48 795.4
M2
MW
711.4
303.13 ' .9
P i8MW42
23.7
MW-12D
418 2
MW-14 r } I MW-12
SUB
— s- --1f- —41- STATIONt
^7379r
W A f �.
i TAN
10
Syr i� MW41 ~ MW-13D
40 R - MW-11 � >�
RW-2 3,070.6
r
MW-28
MW-31
RW-4 -32
A MW-33+
10,000
47
1,000
CT
BDL
MV1f-44
EXISTING
PARKING
EXISTING
PARKING
EXISTING
BUILDING
LEGEND
INJECTION WELL LOCATION
3,070.E TOTAL VOCS CONCENTRATION (U9I1.)
MWAS MONITORING WELL LOCATION WITH
15.9 TOTAL VOCS CONCENTRATION (U9I1.)
37.9 TOTAL V0Cv CONCENTRATION (U91L) IN DEEP WELL
0 RW-7 RECOVERY WELL LOCATION
t,000i� TOTAL VOCe ISOCONCENT1iATION LINE (SHALLOW 4
LOW WELLS ONLY) TOTAL VOCs CONCENTRATIONS
NOTE: Gilbarco
KL E/NFEL DER 7300 West Friendly Avenue
SAMPLES COLLECTED JUNE 21, 2012. Greensboro, North Carolina
Bright People. Right Solutions.
APPROVED BY.
313 GALLIMORE DAIRY ROAD DATE: 07-10.2012 SCALE i• j9"
GREENSBORO. NORTH CAROLINA
PHONE: [phone] DRAWN 8Y d'JF PfOACT ND

EXISTING
PARKING
*MW-5O
�MUV 51 _ y BMW-52
/ II .
MW 48 1787.2 o lWw5
li IW-13
j*IW -12
d�P IW-11
673.4
-5 MW-45
7.4 * IW4 15.9
NM-2 MW 16
1 21.3
MW43U 2
463.E
(f JS4
1 1.a
MW-14
--+�
36
-A-yr
I
r-34
LEGEND
MW 7
INJECTION WELL LOCATION
312.6
TOTAL CHLORINATED HYDROCARBONS CONCENTRATION (upll)
MW-45
MONITORING WELL LOCATION WITH
15.9
TOTAL CHLORINATED HYDROCARBONS CONCENTRATION (upll) IN SHALLOW WELL
36
TOTAL CHLORINATED HYDROCARBONS CONCENTRATION (I*&) IN DEEP WELL
MW-54D
PROPOSED WELL LOCATION
RW-7
RECOVERY WELL LOCATION
tsIJL—,
TOTAL CHLORINATED HYDROCARBONS LSOCONCENTRATION LINE (SHALLOW WELLS ONLY)
NOTE:
SAMPLES COLLECTED JUNE 21, 2012.
PW4.
MW-12D
+—
P•
MW-12
i
i' mW il* SUB
1
STAT ION#
T
WATER I -
TANK ^
MW-13D
MW-41 a��MW-10
QRW-3
1
MW-11
\ 312.6
MW-23D
,FNV-2_
*MW-28
RW-4
MW-31
MW-32
MW-27
1 L
MW-30
MW-
EXISTING
BUILDING
BDL
11

FIGURE 6: INJECT I ON WELL INSTALLATION SKETCH
PROJECT Gilliam
WELL NUMBER IW-1 THROUGH IW-16
PROJECT NUMBER 971,46
CONSTRUCTED ON AUGUST 2012
SURVEYED BY
DEPTH TO WATER FROM
SURVEYED FROM
TOP OF WELL CASING aon[azimately 22 feet
ELEVATION OF GROUND SURFACE
WATER LEVEL ELEVATION
ELEVATION OF TOP OF WELL CASING
WATER LEVEL MEASURED ON
NOTE: DRAWING NOT TO SCALE
GROUND SURF
SURFACE PROTECTION 10" Steel FlnfhmOant Cover
THICKNESS OF SURFACE SEAL 3' Neat Cement Groat
I.D. OF CASING 24sch
TYPE OF CASING Schedule 40 PVC
TYPE OF SEAL BentOnlh
TOP OF ELEVATION OF FILTER PACK
TOP OF ELEVATION OF SCREEN
SIZE OF SCREEN OPENINGS Me
WELL SCREEN DIAMETER
TYPE OF FILTER PACK Filter Sand
BOTTOM ELEVATION OF SCREEN
BOTTOM ELEVATION OF BORING
DIAMETER OF BOREHOLE 64eh

FIGURE 6: INJECTION WELL INSTALLATION SKETCH
PROJECT Gilbarco
WELL NUMBER IW-1 THROUGH IW-16
PROJECT NUMBER 9"46
CONSTRUCTED ON AUGUST 2012
SURVEYED BY
DEPTH TO WATER FROM
TOP OF WELL CASING ADDroXimatdv 22 feet
SURVEYED FROM
WATER LEVEL ELEVATION
ELEVATION OF GROUND SURFACE
WATER LEVEL MEASURED ON
ELEVATION OF TOP OF WELL CASING
NOTE: DRAWING NOT TO SCALE
GROUND SURF
SURFACE PROTECTION 10" Steel Fluahmoant Cover
THICKNESS OF SURFACE SEAL 3' Nett Cement Grout
I.D. OF CASING 24nCh
Schedule 40 PVC
TYPE OF CASING
BentOnlh
TYPE OF SEAL
TOP OF ELEVATION OF FILTER PACK
TOP OF ELEVATION OF SCREEN
0.010
SIZE OF SCREEN OPENINGS
2-inch
WELL SCREEN DIAMETER
#2 Filter Saud
TYPE OF FILTER PACK
BOTTOM ELEVATION OF SCREEN
BOTTOM ELEVATION OF BORING
6-Inch
DIAMETER OF BOREHOLE

A Al
870- ........... : ............................... .. 870
A ...................... ...................................................
........... . ......................................................... ...... .................... 0...1...'p ....... 'p
p .4
'N'pp
GROUND SURFA­
860- .............. ....... ........ ... .. .............. .. 860
00
............... . .... ................ ...... .................... ....... ■ ........... .. .....
■
■
On
A ■
850- . . . ........................ .... ..... ....... ....... .. ... 32;000-850
qp ..........
II
SOIL TYPE: Grey-Grmn Sm* :*6
SILT to Brown Sitty SAND with 0.
ll 0,022 Ile I
Roa Frarnaft 1 10,000
.... 71 . .... .. .... . ... .... 'I ..... ............ ....... A a - . . . . . . . . . . . . . . . . . . . . . ..............
f 1 1
0 "7. -Ili I f
1p 1,"2
■............
840-. 4 NV ...... ...........I....... 11. 840
+
10* N 7
4c 11 01
2LLI
LLI 3.7 ...... S�T,4TIr.vYATjEftjLFyFL, .i. ...........• LU
W ....... ..........
LL. APPROXIMATE WEATHERED 0 ............ ... .. LL
3 11
• 0 5.9 ROCK SURFACE 636.7 100 Z
z
a0
z
830 y ..... ... 4 1 -v - I I ........ -/ .. ... ........... \ . ............ .............. DL 830 0 fLi
_j
coca APPROXIMATE
Vi aB
65.2 BEDROCK SURFACE
uj BDL 16 267.1
i a _j
LUJL . . . ............ ........ .
VN
0 WEATHERED ROCK: ............... ............. ............................... ............ ............... ILI
18.
As Brow. S" SAND
Rock Frag
820- ....... . ................................................................... ...... ................. 820
3.1
............................
11A
BEDROCK: Metammurpbased
100 Gabbro mW Diorke
810- 1100 **.% ................ ................................... .......... ............................... ................. -810
100
................ ... / ....BDL ........................................................................... .................
■
800 800
0 40 80
EXPLANATION
■
SCREENED INTERVAL WITH ISOCONCENTRATION LINES
446.6 TOTAL VOCs IN PARTS PER BILLION
GROUNDWATER CONTOUR LINE
WATER TABLE
NOTE: TOTAL VOC CONCENTRATIONS OF MONITORING WELLS SCREENED ACROSS THE
THE WATER TABLE, BASED ON JUNE 21,2012 GROUNDWATER SAMPLING EVENT.
............................................ I ....................... ............... W ..............
120 160 200 240
DISTANCE IN FEET
(SCALE: I w=40')
280 320 360 400 440

1—
W O
W
Z of 830
Z
O LU
J
QQ
� V
W
J
W
820
790 �.y� �....................
0 40 80
EXPLANATION
TSCREENED INTERVAL WITH 0" ISOCONCENTRATION LINES
446.6 TOTAL VOC9 IN PARTS PER BILLION
• � GROUNDWATER CONTOUR LINE
•
WATER TABLE
NOTE: TOTAL VOC CONCENTRATIONS OF MONITORING WELLS SCREENED ACROSS THE
THE WATER TABLE, BASED ON JUNE 21, 2012 GROUNDWATER SAMPLING EVENT.
120 160 200 240 280 320
DISTANCE IN FEET
(SCALE: 1" = 40')
r,KLEINFELADER
_ J Bright People. Right Solutions.
-�f 313 GALLIMORE DAIRY ROAD
��Y� GREENSBORO, NORTH CAROLINA
PHONE [phone]
360
1— C—
W p
W
830 Z =I
O IJJ
� J
QQ
LU
V
W
J
W
820
790
400
FIGURE 8
CROSS SECTION B-B'
WITH TOTAL VOC ISOCONCENTRATION LINES
Gilbarco
7300 West Friendly Avenue
Greensboro, North Carolina
APPROVED BY: HORIZONTAL SCALE: V = 40'
DATE: 07.30-2012 VERTICAL SCALE: 1' = 10'
DRAWN BY: AB � PROJECT NO: 97746

SUPPORTING MATERIALS
PERMIT REISSUANCE
OF
APRI L 20, 2010

so
90
J� DIN
\ ; i / 1�l / • + III �, • - • C
UR0 N.aN T
'� JJI i EM • �!/. n �• • �• � �
x 998
0 \ \0 i � � I R •I •
BM
li
/ �0 9O�
LJ l -� • •� • •° ,` , � . � \ 'fie
OF
9 go
� aGas9lin • � �i e• � .I�I •
°•• ° ( • •• �� 1 •II
94
P as
00
Ch
O �
01
lip
'° s ,° j )•, yam/'
d
SCALE: DATE: APPROVED BY: SOURCE: 1951 (Revised 1994) USGS
1" = 2,000' 8/15/07 Topographic Map Guilford Quadrangle
Gilbarco
7300 West Friendly Avenue
ITR��7�N. Greensboro, North Carolina
Tri on Project No. 042 -216
Trigon Engineering Consultants, Inc. FIGURE
313 Gallimore Dairy Road SITE LOCATION MAP 1
Greensboro, North Carolina 27409 L I

870.......................................... .. ........................................................... ..,...,..................... ..I.....
Fyn ���
1� 0
OF
......................... ........................................
... �l � .. tin 5�. .........
,�1 ... ay, ♦a ... ..............
APPROXIMATE �ti� ry^n ,yam b� D� w� t�
GROUND SURFACE \ ��4 �4� 0 !0 16
0 °
860 ....................... �.. I I..... ..
� � I I
\ •
N.
�•
850 r / ; 46� ......... ; . .
SOEL TYPE: Grey -Green Sandy \ ; ` ■ ■ 1 32,000
SELT to Brown Silty SAND with \ \ / ■ • " ■■
Rock Fragments : 10,0220,000
: ; ; ; °■ e
■ ■ ° •
■ : * 1,442 / 447
840-- 72 .....
STATIC WATER LEVEL ■ ■ / • ■ ` \ • ■
r_ 1,000
■
Y�I ^ s �•
r ► ■° APPROXLM.ATE WEATHERED • ° ■ ■ - .� ■ .
ROCK SURFACE * 36.7 : °° 100
a
a 830 g ................. — — _ — '.........
■ d ■ _ d� • APPROXIIIA'IE 0 ` — : > U BEDROCK SURFACE —
W V� ■
a ■
■
WEATHERED ROCK: Samples
As Brown Silty SAND with Q •
Rock Fragmenb v
820 .........
i
BEDROCK: Metamorphosed
Gabbro and Diorite
810 F ........
IAt
1870
1860
1850
840
F
Wr .�
YTw ^
rZ.i II
Z
Q ..
830
W x
a �-
W
820
810
800 � Q I � 800
0 40 80 120
EXPLANATION
T
SCREENED INTERVAL WITH ` • ISOCONCENTRATION LINES
477.3 TOTAL VOCs IN PARTS PER BILLION
WATER TABLE
NOTE: TOTAL VOC CONCENTRATIONS OF MONITORING WELLS SCREENED ACROSS THE
THE WATER TABLE, BASED ON DECEMBER 2006 GROL`NI)WATER SAMPLING EVENT.
160 200 240
DISTANCE IN FEET
(SCALE: 1" = 401)
280 320 360 400 440

EXPLANATION
860
1. 4. 1b .
................................................................. 860
C ■
°■
• ° •
■. ... ° .. ............................................... ..
,810 ej a APPROXIMATE SUP -FA pIN 0-46
• � URFACE
850 . ° .. 46.6 ° •' ' ..... 50
GROUND S
.......................................
■
°.° 10,000\ e n 32,000 / STATIC WATER LEVEL
ool a n �.�.�.. • ....... . /........ �
We. .......... .........
°eye 1000 ■.. ' /
n 4,070 0 L — — — • / SOD, TYPE: Grey -Green Sandy
■ '' ■ / / SH.T to Brown Silty SAND with
e °
84U °• .. .� �./... �.......... Rock Fragments
\ . • �. y ....................... ..... 840
° \ 472.7 / ■
. ........ .... ° . ■ . �. ...... ... %PPRO\1NI171 N FATHERED °e
�� ■ LPPRONINI %TE II Z 830u �.Tr..............................°°..�..... ............... ..........BEDAOCIiSIRF�tf........... 83O z
Z �.. -
Q •• ° WEATHERED ROCK: Samples
As Brown Silty SAND with Q
F" °o _ Rods Fragments F
Q ` ... .. °..................................................................................... .. d
> ° ■....... Q
■
W v�
W ■ a � v
■ • W
820 o...................... ........... I ......... I ...... ....................... I .............. .. 20
■ u ..................
810
800
790
■
u BEDROCK: Metamorphosed
o Gabbro and Diorite
■
■
a
0
■
o........................................................................................... 10
•...................................... .. 8
°■ ,
0
■
■
•
e
e
e
■ ............................................................. 800
a
•
e
e
■
e
•
•
■ e
■ e
..... 790
0 40 80 120 160 200 240 280 320 360 400
DISTANCE IN FEET
(SCALE: P=401)
* 46.6 SCREENED INTERVAL WITH
ISOCONCENTRATION LINES
■ TOTAL VOCS IN PARTS PER BILLION
WATER TABLE
NOTE: TOTAL VOC CONCENTRATIONS OF MONITORING WELLS SCREENED ACROSS THE
THE WATER TABLE, BASED ON DECEMBER 2006 GROUNDWATER SAMPLING EVENT.

-1$�-MW-45
835.�
�IW-42
M�1-16 MW-43D
55
MW-24
106
MW-14 MW-15
MW-25
' TATI
835
835ATER
TANK
84
"loom
MW41
MW-10
10,022
850
a 375
3
MW-4 84,
MW 7
1,442
27710
840 �
5
unn
MW-
50
MW-34
MW-28
4,070
R21,810 ,` MW-32 RDL
4
32,000
MUM
MW-2
-30
__ ,598
65.7
850
845
MW-44.
850
EXISTING
PARKING 855
LEGEND
EXISTING
BTEX ISOCONCENTRATION LINE
BUILDING
840 GROUNDWATER CONTOUR LINE
MW-7 MONITORING WELL LOCATION/BTEX CONCENTRATION
3,500
MW-7 -6� PROPOSED iSOC LOCATION
RW-3 A RECOVERY WELL LOCATION
SAMPLES COLLECTED ON AUGUST 24 and 25, NOVEMBER 1, AND DECEMBER 14,
2006
CONCENTRATIONS IN MICROGRAMS PER LITER (ug/ L), ANALOGOUS TO PARTS PER BILLION
840
MW-12D
MW-12
MW-13D
nnMW-13
�(
MW-11 y HDL
MW-23D
325
845
850
855
EXISTING
PARKING
PROPOSED iSOC (Oxygen) LOCATIONS
ffAwlk
GILBARCO
7300 WEST FRIENDLY AVENUE
IMK313 4GREENSBORO, NORTH CAROLINA
Date 812/07 Seale V =100'
ENGINEERING CONSULTANTS, INC.11 Drawn by CW I Figure 10

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mav 22, 2015
Robert Bondos
Gilbarco, Inc.
7 300 West Friendlv Avenue
Greensboro, NC 27410
Ref: Issuance of Injection Well Permit WI0400091
Gilbarco, Inc., Guilford County, NC
Dear Mr. Bondos:
Donald R. van der Vaart
Secretary
In accordance with the application received on April 14, 2015, and the supporting data
previously submitted, XATe are forwarding permit number WI0400091 for the continued
operation of an injection NATell system at the facility referenced above. This permit shall be
effective from the date of issuance until May 22, 2020, and shall be subject to the conditions and
limitations stated therein, including the requirement to submit a final project evaluation as
stated in PART V1I - MONITORING AND REPORTING REQUIREMENTS. Please read the
entire permit to ensure that you are aware of all compliance requirements of the permit.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you
must submit an application to renew the permit 120 days prior to its expiration date. Please
contact me at 919-807-6412 or [e-mail] if you have any questions about your
permit.
Best Regards,
l Jr%
Thomas Slusser, L.G.
Underground Injection Control Program Manager
cc: Sherri Knight, WQROS Winston-Salem Regional Office
Chris Fia}-, EviroTrac Ltd. (via email)
A'94Mtl'Q'f' `rpm l i i tt Pi?iW

`l GILBAi6C0 NF.EDER-ROOT
February 6, 2015
Charles Wakild
Director, Division of Water Quality
NC DENR
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
RE: Underground Injection Permit W10400091
Dear Mr. Wakild:
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: [phone]
Fax: [phone]
www.gilbarco.com
This letter serves as official notification that I am replacing Mario Iannantuono at Gilbarco Inc.
located at 7300 West Friendly Avenue as signatory official in regards to this permit.
Rob Bondos, Vice -President of North American Operations
336-547-55371 (Office)
Rob. bondos&gilbarco.com
If you require additional information please contact John Burke, Senior Environmental
Engineer, at 336-337-2746 or john.burke(a�gilbarco.com
Sipce4ely,
Rob *Bonos
Vice -President of North American Operations
Cc: Mark Dowdy
Lance Miller
John Burke

cILBARco
vex -soar
February 6, 2015
Charles Wakild
Director, Division of Water Quality
NC DENR
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
RE: Underground Injection Permit W10400091
Dear Mr. Wakild:
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: [phone]
Fax: [phone]
www.gilbarco.com
Water Quality Regional
Operations Sect or1
This letter serves as official notification that I am replacing Mario Iannantuono at Gilbarco Inc.
located at 7300 West Friendly Avenue as signatory official in regards to this permit.
Rob Bondos, Vice -President of North American Operations
336-547-55371 (Office)
Rob.bondosna gilbarco.com
If you require additional information please contact John Burke, Senior Environmental
Engineer, at 336-337-2746 or Fohn.burkeggilbarco.com
Sinc`e-tely,
Rob Bondos
Vice -President of North American Operations
Cc: Mark Dowdy
Lance Miller
John Burke

' GILBARGO
VEEDER-ROOrr
v
February 21, 2013
Charles Wakild
Director, Division of Water Quality
NC DENR
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
RE: Underground Injection Permit W10400091
Dear Mr. Wakild:
- W.1 U Joao c�
Gilbarco, Inc.
7300 W. Friendly Ave.
Greensboro, NC 27410-2087 USA
Telephone: [phone]
Fax: [phone]
www.gilbarco.com
This letter serves as official notification that Jeanne Young is replacing Roy Walker at Gilbarco
Inc. located at 7300 West Friendly Avenue as signatory official in regards to this permit.
Jeanne Young, Acting Vice President, North American Operations
336-547-5283 (Office)
Jeanne. youn ggilbarco.corn
If you require additional information please contact John Burke, Senior Environmental
Engineer, at 336-337-2746 or john.burke(a�ailbarco.com
Sincerely,
Sarita Allen
Director, Environmental Health Safety
Cc: Jeanne Young
John Burke
RECEIVEDIDENPOW0
MAR 01 !L:
Aquifer Protection Section

INJECTION EVENT RECORD
North Carolina Department of Environment and Natural Resources - Division of Water Quality
Permit Number_ W t C-1-1 M&% .r
1. Permit` Information
Permittee
sfttw__
Facility Name o
Facility Address ��evSS�oso 1 ZO
2. Injection Contractor Information
W&C �&�" I
Injection Contractor / Company Name
Street Address ­611 L vvlz-rk
G>(x"S\,ptr6 rAC 09
City State Zip Code
(3) u(a8 -oo
Area code - Phone number
3. Well Information rr-
Number of wells used for injection ((P 11
Well names %N-1 � A
Were any new wells installed during this injection
eve ?
[Yes ❑ No
If yes, please provide the following information:
Number of Monitoring Wells D
Number of Injection Wells 1LD
Type of Well Instal�led �heck applicable type):
❑ Bored [R milled ❑ Direct -Push
❑ Hand -Augured ❑ Other (specify)
Please include two copies of form GW-1 b for each
well installed.
Were any wells abandoned during this injection
event?
❑ Yes [;3"No
If yes, please provide the following information:
Number of Monitoring Wells
Number of Injection Wells
Please include two copies of the GW-30 for each
well abandoned.
4. Injectant Information
¢o► SAS -%.ZNMV_
InjectaAf Type
Concentration I -1 O Cy� W ly�
If the injectant is diluted please indicAate,the source
dilution fluid. _MUi-AXI .� V4&a
Total Volume Injected W 1 ',D
Volume Injected per well &D ���
5. Injection History
Injection date(s)-_� 4IIr Z /Z/�� r�-
Injection number (e.g. 3 of 5) / op
!Lt>is the last injection at this site?
[Yes ❑ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
S ARD LAID OUT IN THE PERMIT.
c33
SI AANRE OF INION CONTRACTOR ATE
Cvn-�-4� -
PRINT NAME OF PEkSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injecdoiL . Form UIC-IER
Attn: UIC?rogram, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221 Rev. 07/09

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: W 10400091
Permittee Name: Gilbarco, Inc.
7300 West Friendly Avenue, Greensboro, NC 27420
Please check the selection which most closely describes the current status of your injection well system:
1) ❑ Well(s) still used for injection activities, or may be in the future.
2) ® Well(s) not used for injection but is/are used for water supply or other purposes.
3) ❑ Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) ❑ Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
rel tt,,nnfformat o
19 s insra%ed at MW-29, MW-47, and MW-49 will be moved to MW-42, MW-30, and MW-14.
MW-29, MW-47, and MW-49 will continue to be used for monitoring wells.
Well Abandonment
If you checked (3)(a) or (3)(b), describe the method used to abandon the injection well. (Include a description of how the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission of the
permit. Do you wish to rescind the permit?
❑ Yes ❑ No
Certification:
"I hereby certify, under penalty of law, that I have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
Ow 4�t ,7 i3
Signature U Date
Revia d 594* GW/UIC-68

�. �Vl (71
NONRESIDENTL4L W1 UCTTON RECORD
North Carolina Deparunent of Environment and Natural Resourccs- Division of Watt Quality, �w
�* WELL CONTRACTOR CERTIFICATION #JJ--
1. WE CONTRACTOR:
Well Contractor (Individual) Name
rA• L OA, c�-XP/0r,+-'r7oA-1
Well Contractor Company Name
51-0 1A-1 2)CJ e77Z-I,+I +V tf
Street Address
foltroWS 2? yo
City or Town State Zip Code
d. TOP OF CASING M FT. Above Land Surface'
'Top of casing terminated aVor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
= f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
3(, 34) T3 7 - I � I � : Top Bottom Top Bottom
Area code Phone number Thic n"
2. WELL INFORMATION: l : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# EJ"IZ`IVI��O 1 Top_0 Bottom_ Ft 2p sr� pro
OTHER ASSOCIATED PERMTT#(if applicable) :Top' Bottom Ft
SITE WELL ID #(ifapplicable) : Top Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Munldrol(Public ❑
Industrial/Commerclai p Agricultural ❑ Recovery ❑ Injection KL-��
Irrigation❑ Other ❑ (list use)
DATE DRILLED-1 • 4 - I ?-
8. GROUT: Depth Material Method
TopsBottom_ FLT ZEJ-+( JOt.L_
Top Bottom Ft
Top Bottom Ft.
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size Material
:Top r ? Bottom ?� Ft 1. f /C1 in. PuL
(Street Name, Numbers, Community, SubdMsiwi oN , Parcel, Zip Code)
�+ ,�-- Top Bottom Ft in. in.
CITY. � Du'`�S� COUNTY �Jt : Top Bottom Ft in. in.
TOPOGRAPHIC / SETTING (amcit appropriate box)
❑Slope ❑Valleyy ❑ at ❑Ridge Other : 10. SAND/GRAVEL PACK:
LATITUDE 35 7� DMS OR �— Depth Size Material
DO : Top
_JI_Botlwn r _ Ftjr Sr/,rt—
LONGITUDE 80 JDMS OR DD : Top Bottom Ft.
Latitude/longitude sauce: BPS RfTopographic map : Top_______Bottom Ft .
(/ocation of well must be shown on a USGS tepo map andattached to
this form if not using GPS) ; 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) Top Bottom Formation Description
�: (D
Facility Name acility ID# (rf applicable) /
VJQ—X
Street Address /
6�4-ecn-AV-1irsr ® rJc
City or T0WV ` t� State Zip Code /
SatTl 7/`�1 /
Contact Name = /
SavWL /
Mailing Address /
City or Town State 23p Code
3c sto) 5gi —Sd�
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOE -SWELL REPLACE EXISTING WELL? YES ❑ NO Lys
c. WATER LEVEL Below Top of Casing: _
(Use '+' if Above Top of Casing)
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA Nf J.0 x. WELL r.ONSFRUCrrON STANDARM. AMD Tk^T A COPY OF THIS
REC=HASPROVIDED TO T Hrz WCU OWNER.
S �TTURE OF/CERTIFIED�WWELL.CONTRAC-15R DATE
J�Ci C/4 iGI `o'f TK�- - . s
- PPJWED NAME OF PERM 6)QPSTRUC-TING THE WELL
Submit vvlhin 30 days Of completion to: Division of Water Quality - Information ProcessRev.
ing,
1617 MOM Service meter, Ratelo, N.0 27699-161, Phone : (9?9) t3DT-6300 Rev. 2/G9
09

061
NC _ . RESIDENTIAL WELL CONSTRU )N RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
•a,a " s• .� WELL CONTRACTOR CERTMCATION #
1. CONTRACTOR:
�vald
Wall Contractor (Individual) Name
T,4lGOA- C;eP/0,r.+T70A--'
Well Contractor Company Name
5-1d W 20CJ CT1L),} / ALltr
Street Address
fo!>ra�S goo Alt-
Cityor Town State. Zip Code
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aVbr below land surface may require
a valiance In accordance with 15A NCAC 2C .0118.
e.
r.
YIELD (gpm): METHOD OF TESTS
DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
( ; 4 .) ST 3 - /I �j� : Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# !�`— rv�'Mi ��fl— 1,: Topes_ Bottom_ Ft E-� So` YC.'
OTHER ASSOCIATED PERMIT#(If applioable) ; Top Bottom Ft
SITE WELL ID #(ifapplicable) ; Top . Bottom Ft
3. WELL USE (Check One Boa) Monitoring p Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial p Agricultural ❑ Recovery p Iryedion;X� : Tcp O Bottom _ Ft P-eTIA
Irrigationp Other p (list use)
DATE DRILLED
4. WELL LOCATION:
'�3po r,�JdsT—Fr,c�C
(Street Name. Numbers, Community. Sub&Won, Lbt No., Parcel, Zip Code)
CITY: �✓�'�S'�� COUNTY
TOPOGRAPHIC / LAN ETTING: (dleek appropriate box)
❑Slope ❑Valley2y 2fFlat ❑Ridge ❑OtherApf. -cz�l
LATITUDE 357�°_' ' DMS OR-X DD
LONGITUDE 80 PMS OR ix&nDD
Latitude/longitude source: BPS r/r ographic map
(location of we# must be shown on a USGS topo snap andattached to
this form if not using GPS)
5. FACILITY (Name of the business where the well is located.)
Name . _ 1 ^ , _ 11 Facility ID# (rf applicable)
or Towr • .1 State Zip
Contact Name
Saws
Mailing Address
City or Town State Tp Code
3�) 541 -'Sb0'
Area code Phone number
S. WELL DETAILS: p�
a. TOTAL DEPTH: 0
b. DOES WELL REPLACE EXISTING WELL? YES p NO
c. WATER LEVEL Below Top of Casing:
()Jse.'+' if Above Top of Casing)
Top Bottom Ft.
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top 1_ Bottom 2Sf Ft z in. • LG in. PyL-
Top Bottom Ft in. in.
: Top Bottom Ft In.
10. SAND/GRAVEL PACK:
Depth Size
: Topjj_Sotton_L_t__ Ft 12—
Top Bottom Ft.
Top Bottom Ft.
: 11. DRILLING LOG
In.
Material
S f/rw
: Top Bottom Formation Description
12 REMARKS:
I DO HEREBY CERTIFY TWIT THIS WELL WAS CONSTM CTED W ACCORDANCE WITH
• 1 SA NCAC 2C WE" CONSTRUCTION STANDARDS, AHD THAT A COPY OF TWS
: RECORD 4@ PROVIDED TO THE WELL OWNEP,
SI TURE OF CERTIFIED WELL CONTRAL`rtOR DATE
: PRIWED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW1b
Rev. 2/08
1617 Mai# 99 Service Center, Raleigh, NC 276IM, Phone: (919) 807-ma

�� Sl 1 ryl v R SMENTUL WELL CONSTRU DN RECORD r�
North Carolina Department of Environment and Natural Resources- Division of Water Quality ' 3
WELL CONTRACTOR CERTIFICATION # mod?
1. CONTRACTOR: D
Well t:onttacior (Individual) Name
T• ZA,l - c:�XP/orA-T7o�/
Well Contractor Company Name
576 /N D Cl s-r7Z-4.t I �4ytT
Street Address
NL 2? ` O 6
City or Town State. Zip Code
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
a. YIELD (gpm):
METHOD OF TEST
= f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
Top Bottom
Top
Bottom_T_
Top Bottom
Top
Bottom
Top Bottom
Top
Bottom
Thickness!
2. WELL INFORMATION: 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# D�Z`�-i1Ar�1� 1. Top 1 Bottom 17•9'_­Ft ire Sri. W
OTHER ASSOCIATED PERMIT#(ii applicable) :Top Bottom FL_
SITE WELL ID #(if applicable) : Top . Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection err Top d Bottom 9 3 Ft_.P^M1 r--W T x+_
Irrigation❑ Other ❑ (list use)
DATE DRILLED J? . % • ( 2-
4. WELL LOCATION:
(Street Namr��
e, Numbers, Community, Subdivision, �, Parcel, Zip Code)
�✓ CITY: L �'-56'co COUNTY 4fxjr ^�
Top Bottom Ft
Top Bottom Ft
S. SCREEN: Depth Diameter Slot Size Material
Top if BottomA • 3 Ft Z' in. - /O in.
Top Bottom Ft in. in.
Top Bottom Ft in. In.
TOPOGRAPHIC / LAP16 SETTING: (deck appropriate box)
❑Slope oValleyy 6FIat ❑Ridge ❑Other : 10. SANDIGRAVEL PACK:
LATITUDE 35J6 " DMS OR X DD Depth Size
Top/ 3 Bottom Ft. # Z
LONGITUDE 80 ' pMS OR 7 : Top Bottom Ft.
Latitude/longitude source_ BPS Rkopographic map ; Top Bottom Ft.
f/ocatron of well must be shown on a USGS topo map andattached to
this fond if not using GPS) : 11. DRILLING
LOG
S. FACILITY (Name of the business where the well is located.) Top
Bottom
co
Facility Name acility I
l�applicable)
Street Address
/
City or T State Zip�Code
/
Contact Name
/
SavWL
/
Mailing Address
/
City or Town State Zip Code
(9S to) sill - 56
Area code Phase number
S. WELL DETAILS:
l r�
a. TOTALDEPTH:_ 3
b. DOES WELL REPU4CE EXISTING WELL? YES ❑ NO
c. WATER LEVEL Below Top of Casing: FT.
(Use '+• if Above Top of Casing)
: 12. REMARKS:
Material
cv /• c.«—
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 1SA NCAC ZC. WELL CONSTRyCTON STANDARDS, AND THAT A COPY OF THi
- RECO=BVIDED TO THE WELL OWNER.
g-/ 7-/Z
SIG RE OF CERTIFIED WELL CONTRA651 R — DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form 109
Rev. 2/08
1617 Mail Service Center, Raleigh, NC 27699-1A1, Phone: [phone]WO

A
' Nu1v RESIDENTIAL WELL CONSTRU,..ON RIPCORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRAC'POR CERTIFICATION #
:Zd7 S— I
1. CONTRACTOR
Well Contractor (Individual) Name
-TiLI (ooti. Irk e/y r,+77d.v
Well Contractor Company Name
5—ta Ave -
Street Address
1p�r�S IP,o�G ryc- 2?'f06
City or Town State. Zip Code
3L 34 53'3 - l I I
Area code Phone number
Z WELL INFORMATION: ,� 1 (,�� : 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# L J?e— ly-i—AAVJJib ,�1 ToP Bottom /f,S Ft i`�
1: OTHER ASSOCIATED PERMIT#(if applicable)Top Bottom Ft
SITE WELL ID#(dawlinble)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection t�
Irrigation❑ Other ❑ (list use)
DATE DRILLED
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision. Lbt No., Parcel, Zip Code)
Top . Bottom Ft
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 1 SA NCAC 2C .0 11S.
e. YIELD (gpm): METHOD OF TEST
= f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
: Top Bottom Top Bottom_
: Top Bottom Top Bottom
Top Bottom Top Bottom
Thickness/
Weight Material
: 8. GROUT: Depth Material Method
Top Bottom /r/ Ft Jorru
: Top Bottom Ft
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top [9•C Bottom r Ft. L' in. • /O in. ocr
Top Bottom Ft in- in.
CITY: COUNTY Top Bottom Ft in. in.
TOPOGRAPHIC / LAN ETnNG: (check appropriate box)
❑Slope []Valley t ❑Ridge ❑Other : 10. SAND/GRAVEL PACK:
--v7 Depth Size Material
LATITUDE 3572q (P*_' ' DMS OR X DD : Top/C-<" Bottom /f- 4— Ft L S(�rcr—
LONGITUDE 80 '_' %MS OR 7 DID : Top Bottom Ft.
LatitudeAongitWe source: OGPS prepographic map
(location of well must be shown on a USGS topo nmap andattached to
this form if not using GPS)
S. FACILITY (Name of the business where the well is located.)
�l \co
Facility Name acility ID# (if applicable)
-
Street Address
G rz-eus%1niiitr o r�lc 2 -ZbB
City or Towp A State ZipCode
�c►r Q
Contact Name
Mailing Address
City or Town State Zip Code
(4s to) sill --,,--
Area code Phone number
S. WELL DETAILS: I
a. TOTAL DEPTH: 3 3
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO (l--�
c. WATER LEVEL. Below Top of Casing: FT
(Use'+' dAbove Top of Casing)
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
I
/
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE W"
ISA NCAC 2C. WELL CONSTRUCTION STANDARDS. AND THAT A COPY OF THIS
- RECORD HAS EEN PROVIDED TO THE WFLL OWNER
Q •l2•!2_
TU E OF CERTIFIED WELL CONTRACTOR DATE
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

' Nun/ RESIDENTIAL WELL coNSTRucrION RECORD
;S North Carolina Deparhnent of Environment and Natural Resources- Division of Water Quality w )
�o '.,�• WELL CONTRACTOR CERTIFICATION #
1. CONTRACTOR: r O
A.,1r4-la✓
Well Corffracior (Individual) Name
T�-ltao•�- �XP/a�A-'r7o•�
Well Contractor Company Name
S-!d IN D v s-r7�-s k I i4ytr'
Street Address
fo�o->✓S P,oR-o A/C_ 2? YO6
City or Town State. Zip Code
Area code Phone number
2 WELL INFORMATION'
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 1 SA NCAC 2C.0118.
e. YIELD (gpm):
!METHOD OF TEST
: f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom`T
: Top Bottom
Top Bottom
Top Bottom
Top Bottom
7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# Top-2— Bottom 17 Ft 24
OTHER ASSOCIATED PERMIT#(ff applicable) Top Bottom Ft
SITE WELL ID #(if applicable) : Top . Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ : 8. GROUT: Depth Material
Thickness!
Weight Material
sK Yo
Pce-
lndustriaUCommercal p Agricultural p Recovery[] 4- Top O Bottom 1 Ft �l tom- a a�
Irrigation- Other ❑ (list use) : Top Bottom Ft.
DATE DRILLED`Z-
4. WELL LOCATION:
(Street Name, Numbers. Comn inity, Subdivision. Lht No.. Parcel, Zip Code)
CITY: C-y'"S�'� COUNTY �t 40, rW
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Sae Material
Top 17 Bottom 3L Ft 2- In. • i0 in. ve--
Top Bottom Ft in.
Top Bottom Ft In.
TOPOGRAPHIC / LAN�SETTING: (dick appropriate box)
❑Slope ❑Valley Ek'Ftat ❑Ridge ❑Other : 10. SMiDIGRAVEL PACK:
Depth Size
" LATITUDE � �DMS OR X DD Top 11 Bottom I7
LONGITUDE 80 MS OR Ova*DO : Top Bottom Ft.
Latitude/longitude source: BPS �ipographic map ; Top Bottom Ft.
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) : 11. DRILLING LOG
6. FACILITY (Name of the business where the well is located.) Top Bottom
Facility Name
_ idlity I applicable)
`',
``�l
Street Address
IL/
r&
City or Tow
��� State Zip Code
/
SQi'l
/
Contact Name
/
Mailing Address
/
City or Town State Zip Code 12 REMARKS:
Area code Phone number
6. WELL DETAILS,
a. TOTAL DEPTH: -3 2-
b. DOES WELL REPLACE EXISTING WELL? YES ❑
c. WATER LEVEL Below Top of Casing: _
(Use'+• it Above Top of Casing)
in-
in.
Material
S r6�cp•�
Formation Description
• I DO HERFEY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1a Nf_:AC 2 , WELL &TA WkREW, A O T1 T A COPY CC T14L
- RECORD HAS PROVIDED TO THE WELL OWNER.
Sr Z_
NO RE OF CERTIFIED WELL ONTRAGfOR-- DATE
= PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form G 9
aY p nY - Information Processing, Rev. Z109
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

.Nuly RESIDENTIAL WELL CONSTRvg- juLON RECORD IL (,✓' G
North Carolina Department of Envummmt and Natural Resources- Divisors of Water Quality
WELL CONTRACTOR CERTIFICATION #
1. CONTRACTOR: Q
Well Contractor (Individual) Name
T.G(ooA• crX4/0^+T70,1-1
Well Contractor Company Name
5-16 /N a c/ c-rn.-! I Av tr
Street Address
&./b-r W'9 P,046 NC- 27 'fo 6
City or Town State. Zip Code
3(To- ) M - 1115_
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface"
'Top of casing terminated atfor below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
t DISINFECTION: Type Amount
} g. WATER ZONES (depth):
Top Bottom
: Top Bottom
Tap Bottom
Top Bottom R%
9. SCREEN: Depth Diameter Slot Size Material
Top rBottom �• F t Vo in. .16 in. Pvcr
Top Bottom Ft. In. in.
Top Bottom Ft in. in.
pSlope ❑Valley P(Flat ❑Ridge ❑Other : 10. SAND/GRAVEL PACK:
LATITUDE 35' DMS OR X DD Depth Size Material
Top !3 s— tom, Ft * y
LONGITUDE 80MS OR 7 DD -fop Bottom FL
L.atitudellongihrde source: BPS 1wCompographic, map : Top Bottorrl FL .
(location of we# must be shown on a USGS fopo map andattached to
this form if not using GPS) 11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.) Top Bottom Formation Description
<.-N; f(.0
Facility Name acility ID# (If applicable) /
was
Street Address
City or To State Zip Code
sa� � llm /
Contact Name /
SAM—
Me" Address /
I
City or Town State Zip Code
t -sto) 56 12 REMARKS:
Area code Phone number
6. WELL DETAILS:
a. TOTAL DEPTH- W 1461. e/
b. DOES WELL REPLACE EXISTING WELL? YES p NO V
Top Bottom
Top _ Bottom
Top SotkWn
Thickness/
2. WELL INFORMATION: ,�,� 11 : 7. CASING: Depth Diameter Weight Material
Vkm
WELL CONSTRUCTION PERMIT# OC4? _%_ M* - : Top U Bottom rf �Fi �� qu
OTHER ASSOCIATED PERMIT#(if applicable) : Top Bodw Ft
SITE WELL ID#(itapptlaWal : T0p' Bottom F
3. WELL USE (Check One Box) Monitoring p MunicipaltPublic p ' 8. GROUT: Depth Material Method
Industrial/Commercial p Agricultural p Recovery ❑ Injection : Tap 15% Bottom fte f— Ft. W La�� r>bll,-
Irrigationo Other p (list use) : Tap Bottom Ft
DATE DRILLED -V-
4. WELL LOCATION:
73oe t.�,,�s t•-,F�,a..-,�t� s�v1r'
(Street Name. Numbers. Conwn rity. Subdivision, t.bt No., Parcel, Tip Code)
CITY: COUNTY
TOPOGRAPHIC / LAND SETTING: (clmdc appropriate boot)
c. WATER LEVEL Below Top of Casing: FT.
(Use'+• if Above Top of Casing)
100 HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORnANCE WITH
1 SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER -
SIGNATURE OF CERTIFIED WELL CONTRACT DATE
a�,•...�-�--
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

1f »,
f � Nt,. RESIDENTIAL WELL coxsTRL'.. ..ON RECORD , 7
5 North Carolina Department of Environment and Natural Resources- Division of Water Quality
WELL CONTRACTOR CERTIFICATION # '�
1. CONTRACTOR:
Well Contractor (Individual) Name
T/ l c-,oA- L =,e4101A-T JOA/
Well Contractor Company Narne
S/d /N a v 4TiZf *
Street Address
City or Town State Zip Code
d. TOP OF CASING IS FT. Above Land Surface'
`Top of casing terminated aVor below land surface may require
a variance in accordartoe with 15A NCAC 2C .0118.
a. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Area code Phone number n,;,esy
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# FJ�[Z` w-/�Y��� 1 Top_Q_Bottom­13 Ft 2" Sd. YD _ V--
OTHER ASSOCIATED PERMIT#(if appkable) Top Bottom Ft
SITE WELL ID #(if applicable) _
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection fflo,
Irrigation❑ Other ❑ (list use)
DATE DRILLED 3b I,Z
Top _ Bottom Ft
8. GROUT: Depth 2Material
TopQP _ Bottom g Ft Orr tfbl
: Top Bottom Ft
Top Bottom Ft
Method
>P,00A —
4. WELL LOCATION:
: 9. SCREEN: Depth
Diameter
Slot Sae Material
30 e Ly6ST -Prl ff;,-W[ y �} (!fj -
; Top / 3
Bottom a r
Ft Z'' in.
UW in. PIJC
(Street Name, Numbers. Community, Subdivision Lbt No., Parcel, Zip Code)
: Top
Bottom
Ft in.
in.
�t
CITY: t1^�S��O COUNTY
Top
Bottom
Ft in.
in.
TOPOGRAPHIC / LAP SETTING: (check appropriate box)
❑Slope ❑Valley!! E(Flat ❑Ridge ❑Other
: 10. SANDIGRAVEL PACK:
,
Depth
Material
LATITUDE 35��° ' DMS OR X DDFt-
—
'Top �%
Bottom �:�
S I /• ot-
LONGITUDESize
80 `_' ' pMS OR 7 DD
: Top
Bottom
Ft
Latitudellongitude source: BPS epographic map
: Top
Bottom
Ft.
(location of weN must be Shown on a USES topo map andattached to
this form if not using GPS)
11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.)
Top
Bottom
Formation Description
Facility Name acuity ID# Cif applicable)
v�Qs r
Street Address
Gre�cn�Val�r o 1Jc 2"T� Za8`�
City or T State Zip Code
So.r , &A
Contact Name
Mailing Address
City or Town State Zip Code
3c St4, mil —568(.-
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPWO -2-
b. DOES WELL REPLACE fDaSTING WELL? YES ❑ NO`f
c. WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE
WITH
- 1SA "CAC 2C, WELL CON %MRUCTIC" sTA rvwns, AND SLUT A COPY OF TNM
RECORD HAS aEEN PROVIDED TO THE WELL OWNER
NATTU�UUJRE OF CERTIFIED WELL CONTRACTOR
DATE
'Tdlo Y-6t..tit.�
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Fern cw-1b
Y P tty - Information Processing, Rev. vos
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

f� r N&l r RESIDENTIAL WELL CONSTRU aN RECORD
sC
j[ North Carolina Department of Environment and Natural Resources- Division of Water Quality .
• ""° ,� WELL CONTRACTOR CERTIFICATION #
1. CONTRACTOR:
Well Contractor (Individual) Name
Tel c-.oA- c=X Plot,+T7OA-1
Well Contractor Company Name
5-16 IN 20 V C77Z-04 f i4ytT
Street Address
Coltl-�S R�o�G N` 2? '!0 6
City or Town State. Zip Code
3(354
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surtax'
'Top of casing terminated at/or below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top Bottom_
Top _ Bottom
Top Bottom
2. WELL INFORMATION: ,y G� : 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# DMZ- r`�-r—M*J%ib � TOp D Boo JZ, Z- Ft 7'
OTHER ASSOCIATED PERMIT#(lf appr—ble) ;Top Bytom Ft
SITE WELL ID #(if apomble)
3. WELL USE (Check One Box) Monitoring ❑ MunidpaVPublic ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery p Injection Y7�
Irrigation❑ Other ❑ (list use)
DATE DRILLED 7 ' 90 ' /Z
4. WELL LOCATION:
'� 3a e w6sT Sri a�c y l}-�
(Street Name, Numbers, Community, Subdivision, L& No., Parcel, Zip Code)/
CITY: v^'S�� COUNTY �1�'W
Thickness!
Weight Material
2A go pa
Top .
Bottom
Ft
8. GROUT:
Depth
Material
Method
Topes
Bottom Y �l
Ft -
Top
Bottom
Ft
Top
Bottom
Ft
: 9. SCREEN:
Depth
Diameter Slot Size
Material
Top l2- -
Bottom 27. 2
Ft 2.f in. , 16 in.
PLA::,
Top
Bottom
Ft in. in.
Top
Bottom
Ft. in. in_
TOPOGRAPHIC / LANP SETTING: (dveea appropriate box)
❑Slope []Valley tMat ❑Ridge 00ther O
:10.SAND/GRAVEL PACK:
35116-_' DMS OR DD
Depth L Size Material
LATITUDE
Top /D-L Bottom �- Ft S!/-
LONGITUDE 80 "_' MS OR 7 - DD
=Top Bottom Ft.
Latitude/longitudesource: BPS �ipo-raphicmap
- Top Bottom Ft-.
(location of well must he shown on a USGS topo map andattached to
this form if not using GPS)
; 11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.)
Top Bottom Formation Description
Facility Name Facility ID# (if applicable)
/
^ �..
Street Address Q /
City or Towki /� `' n State ZipCode
Sa+ y\
/
/
. tilt
Contact Name
/
Mailing Address
/
City or Town State Zip Code
: 12 REMARKS:
Area code Phone number
6_ WELL DETAILS;
a- TOTAL DEPTH: A—" 2 z(
b. DOES WELL REPLACE EXISTING WELL? YES 0 NO;'
c. WATER LEVEL Below Top of Casing: FT.
(Use'** if Above Top of Casing)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC3C, WELL CONSTRUCTION STANDARDS, AND TNAT A COPY OF T"m
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
t 2—
ATURE OF CERTIFIED WELL CONTRACTOR
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Tam Gw-1b
Rev. 2/09
1617 Mail Service Center, Raleigh, INC 27699-161, Phone: [phone]

7� .
�. 1 r _ l RES`MENML WELL CONSTRL—ION RECORD
. _ North Carolma Depatilnent of Environment and Natural Resources- Division of Water Quality —
•,•; , �,.• WELL CONTRACTOR CERTIFICATION # �o S
1. CONTRACTOR: 'D
ti, 1d T404?A *,—
Well Contractor (Individual) Name
T.�lc�o�- LxP/a��Ttu�
Well Contractor Company Name
5-10 !A,1 a cv CT7?-►,+j i4ytr
Street Address
746
City or Town State. Zip Code
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated aV/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e• YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom
Top Bottom Top Bottom
Top Bottom Top Bottom
Area code Phone number Thickness/
2. WELL INFORMATION: ,�) : 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# C�Z`% -MVj%b b+'�' TOp O Bottom «-Y Ft Z� .40 aG
OTHER ASSOCIATED PERMIT#(if applicable) ;Top Bottom FL
SITE WELL ID #(•If applicable)
3. WELL USE (Check One Box) Monitonng O Municipal/Public ❑
Industrial/Commercial p Agricultural [] Recovery ❑ Injection m/
Irrigation[] Other ❑ (list use)
DATE DRILLED i - 34
4. WELL LOCATION:
300 Lyer;T --Fri 6�• �t y �} f/sr
(Street Name, Numbers, CommurAy, Subdivision, Lbt No., Parcel, Zip Code)
CITY. �f`pZNC'%>J� COUNTY
Top_ Bottom Ft
8. GROUT: Depth Material Method
Top Bottom % y FtlTr.k �L4`•
= Top Bottom FL
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Size Material
Top /(. Bottom -2Z' i FL 7' in. r 00 in. PVC-
Top Bottom FILin. in.
Top Bottom FL In. In.
TOPOGRAPHIC / LAND SETTING: (check appropriate box)
❑Slope ❑Valleyr �lat []Ridge ❑Other : 10. SAND/GRAVEL PACK:
Depth LATITUDE 357(° ' DMS OR c DD S'e Material
��oc :Top � i• Bottom /�-Y Ft ?# Z-- s./•cr
LONGITUDE 80 MS OR 7�000C DD : Top Bottom Ft.-
Latitude/longitude source: (BPS pfopographic map : Top Bottom FL
(location of well must be shown on a USGS topo map andeffached to
this torn if not using GPS) ; 11, DRILLING LOG
5. FACILITY (Name of the business Where the Well is located.) Top Bottom Formation Description
<�'N:Loaf w
Facility Name y acility ID# (if applicable)
"i�OU �Q`� f-� u�Q �1•�ti1� •
Street Address
Cyr-.e-e�n��r o nlc 2-1� -ZaB�
City or T State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
( 's(0) .541-568(�
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO [JY
c. WATER LEVEL Below Top of Casing: FT.
(Use '+' if Above Top of Casing)
11 REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND T/AT A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL OWNER
S*STVA �WELL
'/2 • / 2~
TTU�RE OF CERTIFIED W E . CONTRAC- OR DATE
' U�Utir/a� i1Jal�cv�,f-�1
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Form GW-w
Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone : [phone]

refer
> . s NG., . RESIDENTIAL WELL CONSTRU(-_—�)N RECORD W _ 1 O
i " _ North Carolina Department of Environment and Natural Resources- Division of Water Quality
•� Q,,,, d•,r WELL CONTRACTOR CERTIFICATION # Z
1. CONTRACTOR:
a.vr►(d
Well Contractor (Individual) Name
7244(ooA, 1=25P/0f.+770A,' _
Well Contractor Company a�
Street Address
&I-a-rWS R"O+e-d N` 2? Yo 6
City or Town State. Zip Code
d. TOP OF CASING IS FT. Above Land Surface'
-Top of casing terminated aft below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g, WATER ZONES (depth).
Top Bottom Top Bottom_T_
Top Bottom Top Bottom
f ; 4 ) ��j ' f j f Sr : Top Bottom Top Bottom
Area code Phone number ThirdknessJ
2. WELL INFORMATION: ; 7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT# i'J�IZ`�—M11��D T°p O Bottom Ft
OTHER ASSOCIATED PERMIT#(ff applicabe)
Top Bottom Ft
SITE WELL ID #(If applicable) : Top . Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ MunlcipaUPublic ❑ /
IndustliaUCommercial ❑ Agricultural ❑ Recovery ❑ Injection Q'
Irrigation❑ Other ❑ (Iist use)
DATE DRILLED I -I lL-
4. WELL LOCATION:
`�30e t.y6sT ��r6 r'q {—
(Street Name, Numbers. Community, Subdivision, Lbt No., Parcel. Zip Code)
CITY: ~S'� COUNTY �1�4
8. GROUT:
Depth
Material
Method
Top C
Bottom :�
Ft %s-7L4--4
Top
Bottom
Ft
Top
Bottom
Ft
9. SCREEN:
Depth
Diameter Slot Size
Material
Top /Z
Bottom Z 7
Ft Z in. . to in.
Top
Bottom
Ft in. in.
Top
Bottom
Ft in. in.
TOPOGRAPHIC / LANP SETTING: (d+ecic appropriate box)
oSlope ❑Valleyy f M'Flat ❑Ridge ❑Other, : 10. SAND/GRAVEL PACK:
LATITUDE 35 7�°_' ' DMS OR X DD � Sae
: Top L_Bottom Ft fP-�IT4LO too, L
LONGITUDE 80 PMS OR ixW0,00Me DD : Top Bottom Ft.
Latitude/longitude source: BPS pographic map ; Top Bottom Ft.
(location of well must be shown on a USGS tope rnan andartached to
this form if riot using GPS) : 11. DRILLING LOG
6. FACILITY (Name of the business where the well is located.) Top Bottom
<--%A W
Facility Name acuity ID# (if applicable)
:nw �eln�
street Address
G 0 �r-It �1,
City �rown Alm
State Zip Code
Contact Name
Mailing Address
City or Town State Zip Code
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: /2
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NOgr
c. WATER LEVEL Below Top of Casing: _
(Use'+' if Above Top of Casing)
/
1Z REMARKS:
Material
Sl/rc c -
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1 SA NCAC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THLs
RECORD HAS qF141 PROVIDED TO THE WELL OWNEP,
SIGNATURE OF CERTIFIED WELL CONTRACTOR DATE
ti 4 /11311 7
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-tb
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2M9
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

3" Nc,.,. RESIDENTIAL WELL CONSTRU 3N RECORD
sC
•� North Carolina Department of Environment and Natural Resources- Division of Water Quality -DZA.) W
WELL CONTRACTOR CERTIFICATION #S-
1. WELLCONTRACTOR:
Iva la/ Td o-�ii,.1��
: d. TOP OF CASING IS FT. Above Land Surfaoe
'Top of casing germinated at/or below land surface may require
Well Contractor (Individual) Name
a variance in accordance with 1SA NCAC 2C .0'118.
e. YIELD (gPm): M£Tf= OF TEST
Well Contractor Company Name
: f. DISINFECTION: Type Amount
Street Address
`
: g. WATER ZONES (depth):
6
/olts'a-�S goR-G ,yc� 2-7 O
; Top Bottom Top Bottom
City or Town State. Zip Code
:Top Bottom Top Bottom
Top Bottom Top BONDM
Area code Phone number
Thickness)
2. WELL INFORMATION:
7. CASING: Depth Diameter Weight Material
WELL CONSTRUCTION PERMIT#
Topes_ Bottoms Ft Z" 9A 1W ft<—_
1:
OTHER ASSOCIATED PERMIT#(ilappicable)
Top Bottom Ft
SITE WELL ID #(i►applicable)
: Top . Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
: 8. GROUT: Depth Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection Y
: Topes Bottom_ Ft Fba i A l _
Irrigation❑ Other ❑ (list use)
; Top Bottom Ft
DATE DRILLED ' 1 i / L
; Top Bottom Ft
4. WELL LOCATION:
; 9. SCREEN: Depttr Diameter Slot Size Material
Top /S<-- Bottom Ft Z in. . !O in -
(Street N=e,,Nwnbers. Community, Subdivision. Nd_. parcel, Zip Code)
Top Bottom Ft in. in.
CITY: ar'�5�� COUNTY (f--%-"/-�VrW
: Top Bottom Ft in. in.
TOPOGRAPHIC / LANP SETTING: (check appropriate box)
[]Slope ❑ Valleyy t []Ridge ❑ Other : 10. SAND/GRAVEL PACK:
76_' " DMS OR- X DD Depth Size
LATITUDE 35 : Top1�Bottom / $ Ft
LONGITUDE B0 MS OR 7 . DD : Top Bottom Ft.
Latitude/longitude source: (BPS [Wopographic map ; Top Bottom Ft.
(location of weff must be shown on a USGS topo map andaltached to
this firm if not using GPS) ; 11. DRILLING LOG
Material
6. FACILITY (Name of the business where the well is located.) Top Bottom Formation Description
Facility Name (if applicable)
aS t—t iRt,�
Street Address /
City oZrn�s
State Zip' -Code /
" �'� /
Contact Name /
S6,wtlL /
Mailing Address /
City or Town State
Zip Code
3� sal -Sb8r,
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑
NO (�
c. WATER LEVEL Below Top of Casing:
FT.
. (Use '+" if Above Top of Casing)
12. REMARKS:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
1SA NCAC 2C, WELL C(>NSTRUCTION STANDARDS. AND THAT A COPY OF THIS
- RECORDVIDED T THEW L OWNER ¢
�N%ATURE OF CERTIFIED WELL CONTRACTOR— DATE
PR(NTTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality Form A)g
y p tty - Information Processing, Rev. 2l09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

�'a �` SiNF o •ti
f NGu v RESMENTL4L WELL CONSTRU_ __ 3N RECORD
- Nortb Carolma Department of Environment and Natural Resources- Division of Water Quality ' l
WELL CONTRACTOR CERTHICATION #
1. WEII. CONTRACTOR: , Q
Well Contractor (Individual) Name
7—,-4(00A_ L=XPfo.-A-TTOA-1
Well Contractor Company Name
S^!d /N2)vrr11-1,+/ i4v�
Street Address
folb-a-;"S Q,04G iyC- 2? yo b
C 1y or Town State. Zip Code
: d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom`s
Top Bottom Top Bottom
3( ; 4 5-5-3 - III e;— : Top Bottom Top Bottom
Area code Phone number
2. WELL INFORMATION: ; 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT# PJ"�l�i' /`��/yL1tOi�`. Topes_ mom �y Z`
OTHER ASSOCIATED PERM IT#(Ifapplicable) : Top Bottom R.
SITE WELL ID #(if wftabie) :Top . Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑ - 8• GROUT: Depth Material
Thickness/
Weight Material
s�Cuo
Industrial/Commercial ❑ Agricultural p Recovery Q injection p' : Top_ Bottom & Ft017-t4--/
Irrigation.[] Other ❑ (list use)
DATE DRILLED 4' (, 12-•-
4. WELL LOCATION:
LL
36 w6ST --P!'! 6"I"!z ttmr
(Streot NN?,rne, Numbers. Cmrnunity. Subdrvi m. Lbt No.. Parcel. Zip Code)
CITY: 6,1yy,S�Neo COUNTY
Method
"Poe—,
Top Bottom Ft
Top Bottom Ft
9. SCREEN: Depth Diameter Slot Sae Material
Top /t/ Bottom 2 �Ft Z' in. • O� in_ d
Top Bottom Ft in. in.
Top Bottom Ft. in. in.
TOPOGRAPHIC / L4 SETTING: (check appropriate box)
❑Siope ❑Valley Il�t ORidge ❑Other :10.SAND/GRAVELPACK:
LATITUDE 355
6' ' DMS ORAZ DD Top. �
(� Size
�y Ft
LONGITUDE 80 �% MS OR % DID: Top Bottom Ft.
Latitude/longitude source: BPS pf1pographic map ; Top Bottom Ft_
flotation of weif must be shown on a USGS fopo map andattached to
Ws form if not using G.PS) ; 11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.) Top Bottom
A'a co /
Facility Name acility ID# (if applicable) /
Street Address /
Cyr--e-pcyzwe r o �c 27�i1D -ZDS /
City or Towp State ZTprCode /
San >a kA /
Contact Name /
Mailing Address
City or Town State Zip Code : 12 REMARKS:
Area code Phone number
G_ WELL DETAILS-
a. TOTAL DEPTH: ! J r (D !!
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO
C. WATER LEVEL Below Top of Casing: _
(Use '+' if Above Top of Casing)
Material
S !&�
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
SSA NCAC 2C. WALL CONSTRUCTKW STANDARDS. AND THAT A COPY OF THIS
RECORD H EEN PR VIDED 9, E WFl
�ICNATURE OF ERTIFIED WELL CONTRAaOR DATE
t o Iv. -i� 7Zi9
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1 b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2109
1617 Mail Service Center, Raleigh, NC 2re99-161, Phone: [phone]WO

Nt jv RESIDENTIAL WELL CONSTRU :)N RECORD
North Carolina Department of Environment and Natural Resources- Division of Water Quality I.N ' 3
V#TU CONr UCrOR CERTIFICATION N 20� S-
1.CONTRACTOR:
,�a�d Ta�f�,Kk•—
Well Contracbr (Individual) Name
T1-I&.0A• L:X4/0r.+T70•-1
Well Contractor Company Marne
5-1d /,4., D v sTTL+ &
Street Address
&rarvWS R,046 N` 2? yo 6
City or Town State. Zip Code
3(• ;4) T" - ///5—
Area code Phone number
: d. TOP OF CASING IS _ -_ FT. Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm):
METHOD OF TEST
f. DISINFECTION: Type
Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom T_
Top Bottom
Top Bottom
Top Bottom
Top Bottom
Thickness/
7. CASING: Depth
Diameter Weight Material
WELL CONSTRUCTION PERMIT# CqZ.-%-M_%J%U-1Top_Q Bottom_(?- (-- Ft. Z/' 44 4110
Top Bottom Ft
OTHER ASSOCIATED PERMIT#(Crdapplicabie)
:
SITE WELL ID #(a applicable) : Top _ Bottom Ft
3. WELL USE (Check One Box) Monitoring ❑ MunicipaVPublic ❑ : 8. GROUT: Depth _ Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection Top- — �^ 5- Ft
Irrigationp Other ❑ (fist use) : Top Bottom Ft
DATE DRILLED Top Bottom Ft
4. WELL LOCATION: ; 9. SCREEN: Depth Diameter Slot Size Material
Top Bottom Ft Z in. . (O in. PyL.
(Street Name, Numbers, Community, Subdivision, Lbt No., Parcel, Zip Code)
Top Bottom Ft in. in.
CITY: t�tJ�S6040 COUNTY 6L.) J. ;Top Bottom Ft. —In. in.
TOPOGRAPHIC / LANp SETTING: (crock appropriate box)
❑Slope ❑Valleyr (Flat ❑Ridge ❑Other : 10. SAND/GRAVEL PACK:
LATITUDE 35J1JP° ' DMS OR X pp Depth Size
: ToP1 j/ r Bottom / 3 . Ft.�Z
LONGITUDE 80 MS OR 7 DD :Top Bottom Ft.
Latitude/longitude source: BPS prepographic map ; Top Bottom Ft .
(location of well must be shown on a USGS topo map andattached to
this form if not using GPS) : 11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.) Top Bottom
Facility Name " � acility ID# (if applicable) /
vvQs t-c�xtrb /
Street Address /
G�r-e cn� r o ,Je U!k
City or Tow AY 1 State Zip Code •_ /
So.tn /
Contact Name /
Savut,� /
Mailing Address__ --
City or Town State Zip Code
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH: GIs Cn
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO'V%'
c WATER LEVEL Below Top of Casing: FT
(Use '+' if Abave Top of Casing)
12. REMARKS:
Material
Formation Description
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
I &A NCAC 2C, WFI I CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
REGARD HAS EEN PROVIDED TO TH WELL OWNER.
.(2•r2_
TURE OF CERTIFIED WELL CONTRACT- DATE
= PRI ED NAME OF PERSON CONSTRU 7WtTTHE WELL
Subr*t within 30 days of com letiorr to: Division of Water QualiFormty Rev. /D9
Y P try - Informafion Processing, Rev. 2109
1517 Mail Service Center, �C 27699-16.1, Phone: [phone]

�+ SU%Fo'•4 D
RESIDENTIAL WELL CONYML-.-ON RECORn ,
North Carolina Department of Environment and Na=al Resources- Division of Water Quality —f -t) - f ill
�`'mo"",,", ,r• WELL CONTRACTOR CERTIFICATION #
1. CONTRACTOR:
N,4/Gil —.T-do4A^*i—
Well Contractor (Individual) Name
Well Contractor Company Marne
5-1d /,-, D c/ s-M-1 of i4I/tr
Street Address
61ltro7-1S
City or Town State. Zip Code
3(T;; T"-!IlS
Area code Phone number
d. TOP OF CASING IS FT. Aboye Lend Swface'
`Top of casing terminated aVor below land surface may require
a variance In accordance with 15A NCAC 2C .0118.
e. YIELD (gprn): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom
Top - Bottom
Top Bottom
Top Bottom
2. WELL INFORMATION: 7 7. CASING: Depth Diameter
WELL CONSTRUCTION PERMIT#1i`�—M:l���` Top Bottom L; 'Ft 2`
OTHER ASSOCIATED PERMrr#{ifappiicable) Top Bottom Ft
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municoal/Public ❑
Industrial/Commercial 0 Agricultural p Recovery ❑ Injectiontr-�
Irrigationp Other ❑ (list use) _
DATE DRILLED 4. 3 - (2
Top . Bottom Ft
Thickness/
Weight Material
ad— pvk=
8. GROUT: Depth Material Method
Top d Bottom FL PO r L.4 Amf:- _
Top Bottom Ft_ T�
Top Bottom Ft
4. WELL LOCATION:
; 9. SCREEN: Depth Diameter
300 LJo-ST 0, C% z4-w/
: Top /i•t- Bottom ,24-�`Ft 2- in.
(Street Name, Numbers, Community, Subdivision, Lbt No., Paroel, Zip Code)
TopBottom Ft in.
CITY: COUNTY (SLJt r�
Top Bottom Ft in.
TOPOGRAPHIC / LANp SETTING: (check appropriate box)
❑ Slope ❑ Valley ffPbt ❑ Ridge ❑ Other
; 10. SAND/GRAVEL PACK:
Depth
LATITUDE 35J(D- ' DMS OR X DD
li• Ft tSrize
z
:Top Bottom
LONGITUDE 80 PMS OR 7 - � DD
: Top Bottom Ft.
Latitude/longitude source: BPS [Topographic map
= Top Bottom Ft.
(location of well must be shown on a USGS topo map andaffached to
Ws form if not using GPS) ; 11. DRILLING LOG
5. FACILITY (Name of the business where the well is located.) Top Bottom
Facility Name acility ID# (rf applicable) /
VJQS t'>+1d tl� /
str(ddress
G5-e-t0S\0, ! o J�C
City`or To A�� State Zip Code
%
Contact Name /
Mailing Address /
City or Town
Area code Phone number
B_ WELL DETAILS:
a. TOTAL DEPTH:
/
State Zip Code : 12. REMARKS:
b. DOES WELL REPLACE EXISTING WELL? YES n Naw
c. WATER LEVEL Below Top of Casing_ _
(Use '+' if Above Top of Casing)
$lot size Material
/v in_ Pam,
in.
in-
Material
Sr/icy
Formation Description
• I DO HEREBY CERTIFY THAT THIS W ELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 15A NCAC 2C, WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD WAS B PROVIDED T/O THE OWNER.
SI RE O CERTIFIED WELL CONTRAGIO—R DATE
PRIMED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. ZV9
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: [phone]

+ NRESIDENTIAL WELL CONSTRU, :)N RECORD
I K North Carolina Department of Environment and Natural Resources Division of Water Quality `
!`•m,a ; dr•! WELL CONTRACTOR CERTIFICATION #
1. CONTRACTOR:
rvald T��-f�A'lr4/`
Well Contractor (Individual) Name
7-X4(ooAc C-Xp/00',+T70A-1
Well Contractor Company Name
570 !V D t/ CT72-I & r41/ tf
Street Address
fortra-�S +Q,o�o A/C- 2? `fo6
City or Town State. Zip Code
3t ; 4 105
Area code Phone number
d. TOP OF CASING IS FT. Above Land Surface'
'Top of casing terminated at/Dr below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
: a. YIELD (gpm): METHOD OF TEST
= If. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom Top Bottom_
Top Bottom Top Bottom
Top Bottom Top Bottom
2. WELL INFORMATION: - 7. CASING Depth Diameter
WELL CONSTRUCTION PERMIT# tJ"IZ' 1��MV1���1 Top Bottom (f t Ft L�
OTHER ASSOCIATED PERMIT#(if ipplicabe) Top Bottom Ft
SITE WELL ID #(if applicable)
3. WELL USE (Check One Box) Monitoring ❑ Municipal/Public ❑
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection B--
Irrigation❑ Other p (list use)
DATE DRILLED
4. WELL LOCATION:
(Street Name, Numbers, Community, Subdivision, Lbt No., Parcel, Zip Code)
CITY- l`a/' A-S,5040 COUNTY
Top Bottom Ft
Thickness!
Weight Material
sd YG UC
. 8. GROUT: Depth Material Method
Top U Bottom /- { Ft rTL.d �oT uL
Top Bottom Ft
Top Bottom Ft
• 9. SCREEN: Depth Diameter Slot Size Material
: Top (� Bottom ' �Ft 2- in. - /O in. pU<�
Top Bottom Ft in. in.
Top Bottom Ft. in. in.
TOPOGRAPHIC / LANp SETTING: (check appropriate box)
❑Slope ❑Valley at ❑Ridge ❑Other. of- A :10.SANDIGRAVELPACK;
/ ��"'! Depth _ Size Matertal
LATITUDE ��°`' "DM OR X DD :T�d.( Bottom ICA Ft—Z- Sr/rc,
LONGITUDE 80 MS OR 7� DD :Top Bottom Ft.
Latitude/longitude source: (BPS1z
pographic map :Top Bottom Ft
(location of we# must be shown on a USGS topo map andattached to
this form if not using GPS) : 11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.) Top Bottom
Facility Name acility ID# (if applicable) /
Street Address /
C .e-ecn��aro t\ c 42A
City or Tow State Zip Code /
Contact Name /
Mailing Address
City or Town
3( ISto) .5ql -sbK...
Area code Phone number
S. WELL DETAILS:
a. TOTAL DEPTH:
State Zip Code
12. REMARKS:
b. DOES WELL REPLACE EXISTING WELL? YES d NO��
c. WATER LEVEL Below Top of Casing: _
(Use'+' if Above Top of Casing)
Formation Description
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED W ACCORDANCE WfTH
SSA NCAC ]C, WELL CONSTRUCTICN STANLIARDS, AND TH"T A COPY OF THIS
RECORD HAS BEEN PROVIDED TO THE WELL QWNER.
(� URE OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Form GW-1b
Submit within 30 days of completion to: Division of Water Quality - Information Processing, Rev. 2/09
1617 Mail Service Center, Raleigh, NC 27699-161, Phone: (919) 807�300

Nt, V RESIDENTIAL WELL CONSTRU, )N RECORD
' €
`r w North Carolina Department of Environment and Natural Resources- Division of Water Quality Z-0 — 1 �j
WELL CONTRACTOR CERTMCATION #
1. CONTRACTOR:
Well Contractor (Individual) Name
Well Contractor Company Narne
5-16 !,4/ D v C77Z-►ot / ,4ytr
Street Address
6/,G-rw; go�a NL 2'? yo 6
City or Town State. Zip Code
d. TOP OF CASING IS FT. Above Land Surface -
'Top of casing terminated at/or below land surface may require
a variance in accordance with 15A NCAC 2C .0118.
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top Bottom
Top Bottom
Top Bottom_
Top Bottom
: Top Bottom Top Bottom
Area code Phone number
Thickness/
2. WELL INFORMATION: �J�
; 7. CASING: Depth
�t�
Diameter Weight Material
WELL CONSTRUCTION PERMIT# i 7.'-�D�rVli1���
t Top ii Bottom
, , _--Ft
L SC Yd Ar—
OTHER ASSOCIATED PERMIT#(if applicable)
: Top
Ft
SITE WELL ID #(if applicable)
: Top . Bottom
Ft
3. WELL USE (Chedc One Box) Monitoring ❑ Municipal/Public ❑
; 8. GROUT: Depth
Material Method
Industrial/Commercial ❑ Agricultural ❑ Recovery ❑ Injection la/
: Top j Bottom
JO• f FtcI1—
inigation❑ Other ❑ (list use)
Top Bottom
Ft
DATE DRILLED ' 2 ' (Z
; Top Bottom
Ft
4. WELL LOCATION:
: 9. SCREEN: Depth
Diameter Slot Size Material
7 3oe t-.J�sT ,Fr, 6.•-�iC% lid-
_
I `/• � ` 7• S Ft
?—_in. /a �yG
Top Bottom
• in.
(Street Name, Numbers, Community, Subdivisim Lbt No., Parcel, ZIp Code)
: Top Bottom
Ft
in. in.
CITY: �r7T1NS�0 COUNTY �l/Tar�
Top Bolton
Ft
In. in.
TOPOGRAPHIC / LAVD SETTING: (d-eck appropriate box)
❑Slope ❑Valley tfFlat ❑Ridge ❑Other
: 10. SAND/GRAVEL PACK:
LATITUDE �' " DMS OR X DD
Depth
Top Bottom
_
'y' S Ft.L
Size Material
LONGITUDE 80 MS OR 7 DD
; Top Bottom
Ft.
Latitude/longitude source: [BPS ,typographic map
; Top Bottom
Ft..
(location of we# must be shown on a USGS topo map andattached to
this form if not using GPS)
11. DRILLING LOG
S. FACILITY (Name of the business where the well is located.)
Top Bottom
Formation Description
mil•
�
/
Facility Name
acility ID# (if applicable)
/
WQ�7 t SKYjG
/
Street Address
t-
4—
/
City or Towp
SAr'1
Ak�
State Zip Code
/
/
Contact Name
/
Mailing Address
/
City or Town
(SS kcJ '691 — Sb
Area code Phone number
State Zip Code : 12. REMARKS:
G. WELL DETAILS:
f
a. TOTAL DEPTH:
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO Qe'o
c. WATER LEVEL Below Top of Casing: FT
(Use '+' f Above Top of Casing)
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH
• 1 SA NGC 2C. WELL CONSTRUCTION STANDARDS, AND THAT A COPY OF THIS
RECORD HAS B§EN PROVIDED TO THE WELL OWNER—
SWIRATURE OF CERTIFIED WELL CONTRACTOR DATE
: PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality FormRev. /09
y p rtY - Information Processing, Rev. 2ro9
1617 Mail Service Center, Raleigh, INC 276"-161, Phone: [phone]WO

V N M-; W�
11'r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
September 4, 2012
Roy Walker
Gilbarco, Inc.
7300 West Friendly Avenue
Greensboro, NC 27420-2087
Ref: Issuance of Modified Injection Permit WI0400091
Gilbarco, Inc.
Greensboro, Guilford County, NC
Dear Mr. Walker:
Dee Freeman
Secretary
In accordance with the application received on August 6, 2012, and the additional information received August 8, 2012,
we are forwarding permit number WI0400091. This permit is to inject hydrogen and oxygen to remediate groundwater
contaminated with chlorinated solvents and petroleum hydrocarbons at the facility referenced above. The permit has
been modified to also allow a one-time injection of 3DMe mixture into sixteen new injection wells downgradient of
the initial injection area. This permit shall be effective from the date of issuance until March 31, 2015, shall void
existing Permit WI0400091 issued April 20, 2010, and shall be subject to the conditions and limitations stated therein,
including the requirement to submit a final project evaluation as stated in PART VII — MONITORING AND
REPORTING REQUIREMENTS. Please read the entire permit to ensure that you are aware of all compliance
requirements of the permit. The monitoring plan has been modified from the originally permitted plan.
You will need to notify this office by telephone 48 hours prior to initiation of the 3DMe injection operation at the facility.
In order to continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an application
to renew the permit 120 days prior to its expiration date. Please contact me at 919-807-6352 or at
[e-mail] if you have any questions about your permit.
Best Regards,
David Goodrich, L.G.
Hydrogeologist
cc: Sherri Knight, Winston-Salem Regional Office
Christopher Hay, Kleinfelder Southeast, 313 Gallimore Dairy Road, Greensboro, NC 27409
Gene Mao, Guilford County Dept. of Environmental Health
W10400091 Permit PR
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] North Caroli n a
Internet: www.ncwaterquality.org �atura!!r�
An Equal Opportunity 1 Affirmative Action Employer

Goodrich, David
From: Chris Hay ([e-mail]]
Sent: Thursday, August 30, 2012 9:25 AM
To: Goodrich, David
Subject: RE: Additional Info. Request for Gilbarco Facility W10400091
They are intended for injection once the system is converted over to oxygen to address petroleum hydrocarbons. Thus
far only hydrogen has been injected to address chlorinated hydrocarbons.
From: Goodrich, David [mailto:david.goodrich(c ncdenr.govl
Sent: Thursday, August 30, 2012 9:04 AM
To: Chris Hay
Subject: RE: Additional Info. Request for Gilbarco Facility WI0400091
Chris,
Thank you. Wells MW-13, MW-31, MW-32, MW-40 and MW-41 were intended as injection wells according to the permit
application. Have they (ever) actually been used for injection?
Regards,
David
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]
From: Chris Hay [mailto:CHayftleinfelder.com]
Sent: Wednesday, August 29, 2012 2:33 PM
To: Goodrich, David
Subject: RE: Additional Info. Request for Gilbarco Facility WI0400091
yes
From: Goodrich, David [mailto:david.goodrich(o)ncdenr.gov]
Sent: Wednesday, August 29, 2012 2:28 PM
To: Chris Hay
Subject: RE: Additional Info. Request for Gilbarco Facility WI0400091
Chris,
Thank you for your quick response to my email. Are the ten wells which are not used for monitoring at present (MW-7,
MW-14D, MW-15, MW-16, MW-24, MW-29, MW-43D, MW-25, MW-17, and MW-49) all "active" injection wells?
Regards,
David
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

Goodrich, David
From: Chris Hay [[e-mail]]
Sent: Wednesday, August 29, 2012 2:33 PM
To: Goodrich, David
Subject: RE: Additional Info. Request for Gilbarco Facility W10400091
yes
From: Goodrich, David [mailto:david.goodrich &ncdenr.gov]
Sent: Wednesday, August 29, 2012 2:28 PM
To: Chris Hay
Subject: RE: Additional Info. Request for Gilbarco Facility WI0400091
Chris,
Thank you for your quick response to my email. Are the ten wells which are not used for monitoring at present (MW-7,
MW-14D, MW-15, MW-16, MW-24, MW-29, MW-43D, MW-25, MW-17, and MW-49) all "active" injection wells?
Regards,
David
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]
From: Chris Hay [mailto:[e-mail]
Sent: Wednesday, August 29, 2012 2:13 PM
To: Goodrich, David
Subject: RE: Additional Info. Request for Gilbarco Facility WI0400091
David,
The HiSOC installations at the site were originally in ten existing monitoring wells (MW-7, MW-10, MW-14D, MW-15,
MW-16, MW-23D, MW-24, MW-29, MW-34, and MW-43D). On May 13, 2009 the HiSOC equipment was regloved from
MW-10 and installed in existing monitoring well MW-25. Monitoring well MW-10 continues to be used as a monitoring
well. On December 29, 2011 the HiSOC equipment was removed from MW-23D and MW-34 and installed in existing
monitoring wells MW-47 and MW-49. Both monitoring wells MW-23D and MW-34 continue to be used as monitoring
wells. This makes a total of thirteen monitoring wells at the site that have been used for HiSOC installations. I have
completed and attached a UIC-68 Form for the three wells that were used for HiSOC installations, but are now used for
monitoring only (MW-10, MW-23D, and MW-34) as requested. Please let me know if you require any further
information.
Thank you,
Christopher W. Hay, El, RSM
Environmental Program Manager
Kleinfelder Southeast, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
Office [phone] ext. 113

Goodrich, David
From: Chris Hay [CHay [e-mail]]
Sent: Wednesday, August 29, 2012 2:13 PM
To: Goodrich, David
Subject: RE: Additional Info. Request for Gilbarco Facility W10400091
Attachments: SKMBT C36012082913080.pdf
David,
The HiSOC installations at the site were originally in ten existing monitoring wells (MW-7, MW-10, MW-14D, MW-15,
MW-16, MW-23D, MW-24, MW-29, MW-34, and MW-43D). On May 13, 2009 the HiSOC equipment was removed from
MW-10 and installed in existing monitoring well MW-25. Monitoring well MW-10 continues to be used as a monitoring
well. On December 29, 2011 the HiSOC equipment was removed from MW-23D and MW-34 and installed in existing
monitoring wells MW-47 and MW-49. Both monitoring wells MW-23D and MW-34 continue to be used as monitoring
wells. This makes a total of thirteen monitoring wells at the site that have been used for HiSOC installations. I have
completed and attached a UIC-68 Form for the three wells that were used for HiSOC installations, but are now used for
monitoring only (MW-10, MW-23D, and MW-34) as requested. Please let me know if you require any further
information.
Thank you,
Christopher W. Hay, El, RSM
Environmental Program Manager
Kleinfelder Southeast, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
Office [phone] ext. 113
Cell [phone]
t E/NFE'LOEf7
&,$V ON 00 Avk
From: Goodrich, David[mailto:david.goodrichCai)ncdenr.govl
Sent: Wednesday, August 29, 2012 11:06 AM
To: Chris Hay
Subject: FW: Additional Info. Request for Gilbarco Facility WI0400091
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]
From: Goodrich, David
Sent: Wednesday, August 29, 2012 11:05 AM
To: 'Chris Hay'
Subject: Additional Info. Request for Gilbarco Facility WI0400091
Chris,

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
STATUS OF INJECTION WELL SYSTEM
Permit Number: W10400091
Permittee Name: Gilbarco, Inc.
Address: 7300 West Friendly Avenue, Greensboro, NC 27420
Please check the selection which most closely describes the current status of your injection well system:
1) F Well(s) still used for injection activities, or may be in the future.
2) i K Well(s) not used for injection but is/are used for water supply or other purposes.
3) ❑ Injection discontinued and: a) ❑ Well(s) temporarily abandoned
b) ❑ Well(s) permanently abandoned
c) ❑ Well(s) not abandoned
4) LI Injection well(s) never constructed
Current Use of Well
If you checked (2), describe the well use (potable water supply, irrigation, monitoring, etc), including pumping rate and other
relevant information.
MW-10. MW-23D, and MW-34 are currently used for monitorinq.
Well Abandonment
If you checked (3xa) or (3)(b), describe the method used to abandon the injection well. (Include a description ofhow the well
was sealed and the type of material used to fill the well if permanently abandoned):
Permit Rescission:
If you checked (2), (3), or (4) and will not use a well for injection on this site in the future, you should request rescission of the
permit. Do you wish to rescind the ermit?
❑ Yes the
Certification:
"I hereby certify, under penalty of law, that 1 have personally examined and am familiar with the information submitted
in this document, and that to the best of my knowledge the information is true, accurate, and complete."
��- 1�4 "--I
81 Z
Signature Date
Revised 5/05 GW/UIC-68

Goodrich, David
From: Goodrich, David
Sent: Wednesday, August 29, 2012 11:05 AM
To: 'Chris Hay'
Subject: Additional Info. Request for Gilbarco Facility W10400091
Chris,
In conjunction with the permit modification, we need to ascertain the status of each of the injection wells (including the
ones that were part of the original permit that was issued in March of 2008). According to our records, at least 1S of the
wells have been used (or intended for) injection over the years.
Specifically, we need to know if an injection well is "active" (is currently being used for injection), is "inactive" (intended
for future injection), has had its status changed {to monitoring), is temporarily abandoned (wellhead has been secured
and it will be used in the future), or is permanently abandoned. An injection well whose status has changed to
monitoring needs to have a form submitted to notify us of the change. I am attaching a form herewith.
Thank you.
Regards,
David Goodrich
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

Goodrich, David
From: Chris Hay [[e-mail]]
Sent: Thursday, August 09, 2012 1:02 PM
To: Goodrich, David
Subject: RE: Additional Information Request for the Modification of Gilbarco Permit W10400091
David,
The volume is controlled by putting the complete injection volume in the tote only. This ensures no extra solution is
injected as well as it allows us to move empty totes instead of partially filled totes. A single totes will be plumbed to a
single injection well without additional pressurization. The solution is allowed to drain from the totes to the injection
well be gravity. The injection pressure is simply the head (typically 20 to 25 feet of water) above the water table. Please
let me know if you have additional questions.
Thank you,
Christopher W. Hay, El, RSM
Environmental Program Manager
Kleinfelder Southeast, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
Office [phone] ext. 113
Cell [phone]
(K1- ZIN-c-el- OCR
Y
From: Goodrich, David[ma ilto:day id.goodrich (ccbncdenr.gov]
Sent: Thursday, August 09, 2012 12:06 PM
To: Chris Hay
Subject: RE: Additional Information Request for the Modification of Gilbarco Permit WI0400091
Chris,
Thank you for sending me that information
Could you tell me what measurement and control procedures are going to be used during the injection procedure at
each injection well to assure that the proper (intended) volume of injectant will be placed in the well and that the
injection will be controlled if there is any pressurization going on?
Thank you.
Regards,
David Goodrich
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

From: Chris Hay jmailto:CHay(?Okleinfelder.com]
Sent: Thursday, August 09, 2012 11:34 AM
To: Goodrich, David
Subject: RE: Additional Information Request for the Modification of Gilbarco Permit WI0400091
Trigon Exploration. Certification No. 2075 ( Ron Toothman — driller).
From: Goodrich, David fmailto:david.goodrich�ncdenr.gov]
Sent: Thursday, August 09, 2012 11:29 AM
To: Chris Hay
Subject: Additional Information Request for the Modification of Gilbarco Permit WI0400091
Chris,
I am looking for the name and Certification number of the driller who will be installing the 16 additional injection wells.
Thank you.
Regards,
David Goodrich
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

Goodrich, David
From: Chris Hay [[e-mail]]
Sent: Wednesday, August 08, 2012 1:26 PM
To: Goodrich, David
Subject: RE: Additional Information request for Gilbarco Injection Permit Modification W10400091
David,
Based on our phone conversation, I am providing this email to supply information requested.
The application submitted is for injection of Regenesis 3DMe in 16 injection wells at the downgradient end of the
existing groundwater contaminant plume to address recently discovered chlorinated compounds at elevated
concentrations. The previously permitted injection through the use of HiSOC units in the current configuration will
continue in conjunction with the 3DMe injection. The intent of the injection is to provide treatment and reduce
contaminant concentrations before they have a chance to migrate further downgradient. There is a stream (Horsepen
Creek) several hundred feet downgradient of the existing plume. The injection of 3DMe is anticipated to be completed
as a single event. The 3DMe will be mixed into solution with pumps in 250 — 350 gallon totes at a ratio of one part 3DMe
to 10 parts municipal water. The totes will be plumbed to the injection wells and the solution will be injected by gravity.
The head on the well above the water table has been calculated to create an injection pressure between 5 and 10
pounds per square inch. One to two injection volumes of municipal water will be injected following the 3DMe solution
to help distribute the solution in the subsurface. Based on the size of the well screen and texture of subsurface
materials, we have estimated an infiltration rate between 0.5 and 1.0 gallons per minute for each well. Please see Figure
6 for a details of the construction of the injection wells and Table 3 for injection volumes anticipated at each well
location.
Please contact me if you have any additional questions.
Thank you,
Christopher W. Hay, El, RSM
Environmental Program Manager
Kleinfelder Southeast, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
Office [phone] ext. 113
Cell [phone]
$'+yJAE+izL eay. Rq °'aS Ydi,L056Tt
From: Goodrich, David [ma ilto:david.goodrich @ncdenr.gov]
Sent: Wednesday, August 08, 2012 11:57 AM
To: Chris Hay
Subject: Additional Information request for Gilbarco Injection Permit Modification WI0400091
Mr. Hay:

The Aquifer Protection Section is in receipt of the subject application to modify existing injection Permit Number
W10400091, issued to Gilbarco on March 20, 2008. 1 am corresponding by email to save time.
We are requesting additional information as follows:
Please prepare a detailed written explanation of what you are attempting to do, and the information that is prompting
this action. It is unclear whether the modification is taking the place of previously permitted activities, or is an additional
series of injections.
We need more information about the injections themselves. The best way to provide this would be to complete Page 4
of 7 of FORM UIC-51/5T with injection information specific to this modification.
Please call me with any questions.
Thank you.
Regards,
David Goodrich
Aquifer Protection Section Central Office
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

Goodrich, David
From: Goodrich, David
Sent: Wednesday, August 08, 2012 1:35 PM
To: Knight, Sherri
Subject: FW: Additional Information request for Gilbarco Injection Permit Modification W10400091
Sherri,
The email below is in response to some questions I had regarding the modification of an existing injection permit for
Gilbarco Inc. in Guilford County. Please forward this to the person who is assigned this review. The review package is on
its way to you and should arrive in a day or two.
Thank you.
David
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]
From: Chris Hay [mailto:[e-mail]]
Sent: Wednesday, August 08, 2012 1:26 PM
To: Goodrich, David
Subject: RE: Additional Information request for Gilbarco Injection Permit Modification WI0400091
David,
Based on our phone conversation, I am providing this email to supply information requested.
The application submitted is for injection of Regenesis 3DMe in 16 injection wells at the downgradient end of the
Pxistinw ormindwater contaminant niume to addrecc rerentl discovered chlorinatpH rmmnminde at PlPvatpd
ao r y-^- r-
concentrations. The previously permitted injection through the use of Hi5OC units in the current configuration will
continue in conjunction with the 3DMe injection. The intent of the injection is to provide treatment and reduce
contaminant concentrations before they have a chance to migrate further downgradient. There is a stream (Horsepen
Creek) several hundred feet downgradient of the existing plume. The injection of 3DMe is anticipated to be completed
as a single event. The 3DMe will be mixed into solution with pumps in 250 — 350 gallon totes at a ratio of one part 3DMe
to 10 parts municipal water. The totes will be plumbed to the injection wells and the solution will be injected by gravity.
The head on the well above the water table has been calculated to create an injection pressure between 5 and 10
pounds per square inch. One to two injection volumes of municipal water will be injected following the 3DMe solution
to help distribute the solution in the subsurface. Based on the size of the well screen and texture of subsurface
materials, we have estimated an infiltration rate between 0.5 and 1.0 gallons per minute for each well. Please see Figure
6 for a details of the construction of the injection wells and Table 3 for injection volumes anticipated at each well
location.
�'
Please contact me if you have any additional questions.
7x
Thank you,
Christopher W. Hay, El, RSM
Environmental Program Manager
Kleinfelder Southeast, Inc.
313 Gallimore Dairy Road
-r

Greensboro, North Carolina 27409
Office [phone] ext. 113
Cell [phone]
1 K,LEINFEL DER
&"Now
From: Goodrich, David[mailto:david.goodrich(dncdenr.govl
Sent: Wednesday, August 08, 2012 11:57 AM
To: Chris Hay
Subject: Additional Information request for Gilbarco Injection Permit Modification WI0400091
Mr. Hay:
The Aquifer Protection Section is in receipt of the subject application to modify existing injection Permit Number
W10400091, issued to Gilbarco on March 20, 2008. 1 am corresponding by email to save time.
We are requesting additional information as follows:
Please prepare a detailed written explanation of what you are attempting to do, and the information that is prompting
this action. It is unclear whether the modification is taking the place of previously permitted activities, or is an additional
series of injections.
We need more information about the injections themselves. The best way to provide this would be to complete Page 4
of 7 of FORM UIC-51/5T with injection information specific to this modification.
Please call me with any questions.
Thank you.
Regards,
David Goodrich
Aquifer Protection Section Central Office
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

Goodrich, David
From: Goodrich, David
Sent: Wednesday, August 08, 2012 11:57 AM
To: 'Chris Hay'
Subject: Additional Information request for Gilbarco Injection Permit Modification W10400091
Mr. Hay:
The Aquifer Protection Section is in receipt of the subject application to modify existing injection Permit Number
W10400091, issued to Gilbarco on March 20, 2008. 1 am corresponding by email to save time.
We are requesting additional information as follows:
Please prepare a detailed written explanation of what you are attempting to do, and the information that is prompting
this action. It is unclear whether the modification is taking the place of previously permitted activities, or is an additional
series of injections.
We need more information about the injections themselves. The best way to provide this would be to complete Page 4
of 7 of FORM UIC-51/5T with injection information specific to this modification.
Please call me with any questions. %�7J I� FP
r yy
Thank you. (.� l
Regards,
David Goodrich
Aquifer Protection Section Central Office
Office Telphone Number: [phone]
Aquifer Protection Section Main Number: [phone]
Fax Number: [phone]

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
August 8, 2012
Roy Walker — Vice President US Operations
Gilbarco Inc.
7300 West Friendly Ave.
Greensboro, NC 27420-2087
Dear Mr. Walker:
Dee Freeman
Secretary
Subject: Acknowledgement of
Application No. WI0400091
Gilbarco Incorporated -Guilford
Injection In situ Groundwater
Remediation Well System
Guilford County
The Aquifer Protection Section acknowledges receipt of your permit application and supporting
documentation received on 08/06/2012. Your application package has been assigned the number listed
above, and the primary reviewer is David Goodrich.
Central and Winston-Salem Regional Office staff will perform a detailed review of the provided
application, and may contact you with a request for additional information. To ensure maximum
efficiency in processing permit applications, the Aquifer Protection Section requests your assistance in
providing a timely and complete response to any additional information requests.
Please note that processing standard review permit applications may take as long as 60 to 90 days
after receipt - of a complete application. If you have any questions, please contact
David Goodrich at [phone] or [e-mail].
n
�rL"c'
for Debrk J.,,Watts
Groundwater Protection Unit Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Chris Hay — Kleinfelder Southeast, Inc., 313 Gallimore Dairy Rd., Greensboro, NC 27409
Permit File W10400091
AQUIFER PROTECTION SECTION
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Location: 512 N. Salisbury St., Raleigh, North Carolina 2TW4 One
Phone: [phone] FAX: [phone] NorthCarohna
Intemet: www.nmateraualitv.orn A- _ 1 _ It
An Equal Opportunity 1 Affirmative Action Employer

SUPPORTING MATERIALS
PERMIT REISSUANCE
OF
APRIL 20, 2010

CDEN
North Caroiir i 1-DeGartmen. of Environmen` and N3iural Resour eS
G Division or Water Quaiit��
Deven;v paves Peraue 1oleen K Sulims
Governor Director
April 20, 2010
Rov Walker
Gilbarco. Inc.
7300 Wrest Friendly Avenue
Greensboro, NC 27420-2087
Ref: Issuance of Injection Permit W10400091
Gilbarco, Inc.
Greensboro. Guilford County, NC
Dear Mr. Walker:
Dee rreernan
Secretary
In accordance with the application received on February 25, 2010, and the additional information received March 15,
2010, we are forwarding permit number WI0400091. This permit is to inject hydrogen and oxygen to remediate
groundwater contaminated with chlorinated solvents and petroleum hydrocarbons at the facility referenced above. This
permit shall be effective from the date of issuance until March 31, 2015, and shall be subject to the conditions and
limitations stated therein, including the requirement to submit a final project evaluation as stated in PART VII —
MONITORING AND REPORTING REQUIREMENTS. Please read the entire permit to ensure that you are aware of all
compliance requirements of the permit.
You will need to notify this office by telephone 48 hours prior to initiation of operation of the facility. In order to
continue uninterrupted legal use of the injection facility for the stated purpose, you must submit an application to renew
the permit 120 days prior to its expiration date. Please contact me at 919-715-6164 or Thomas. S lusser(a--)ncdenr.go,, if you
have any questions about your permit.
Best Regards, )
J
Thomas Slusser, L.G.
Program Manager
Underground Injection Control Program
cc: Sherri Knight, Winston-Salem Regional Office
Christopher Hay. Kleinfelder Southeast. 313 Gallimore Dairy Road. Greensboro, NC 27409
Gene Mao. Guilford County Dept. of Environmental Health
W 10400091 Permit File
I�� P✓al; ;:�NIG �en?e: naieta!_ No!tr'i ..Jrohna ^.i tlu_IIC?i.
_o:at:of 2'2G ai) tal Boelevar� kaieiar Pva ar^Im 21-p(
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inte•ne, www nmraterquahA,.org `

Slusser, Thomas
From:
Chris Hay [[e-mail]]
Sent:
Monday, March 15, 2010 1:57 PM
To:
Slusser, Thomas
Subject:
Gilbarco signed permit Application No. W10400091
Attachments:
ATT00001.bmp; D00008.PDF
Christopher W. Hay, E.I.
Environmental Group Manager
Kleinfelder
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
o l 336.668.0093 Ext 113
c 1 336.451.0973
[e-mail]
KL FIA/FFL OFR
�1rrq!i;. F'rart�c. k{4=*" Satutaarn
P' :s
Warning: Information provided via electronic media is not guaranteed against
defects including translation and transmission errors.
If the reader is not the intended recipient, you are hereby notified that any
dissemination, distribution or copying of this communication is strictly
prohibited. If you have received this information in error, please notify the
sender immediately.

Slusser, Thomas
From: Chris Hay [[e-mail]]
Sent: Wednesday, March 10, 2010 2:31 PM
To: Slusser, Thomas
Subject: Re: Gilbarco injection well permit renewal
Attachments: ATT00001.bmp
Thomas,
I will get Roy Walker to sign the certification. The permit application is to continue the process currently operating at
the site. Hydrogen is being supplied to monitoring wells through the use of HiSOC units. Please let me know if you have
any other questions.
Thank you,
Christopher W. Hay, E.I.
Environmental Group Manager
Kleinfelder
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
o 336.668.0093 Ext 113
c 336.451.0973
chay(ftleinfelder.com
KL EINF"EL ADER
Brr�hf �'rora�c krg:h� Sotur:ors
>>> "Slusser, Thomas" <[e-mail]> 3/9/2010 8:49 PM >>>
Greetings Chris,
I just noticed that Roy Walker did not sign the permit application certification, he just signed the property owner
consent portion. We will need his signature for the certification portion as well. Also, for clarification, is this renewal
without modification being submitted just to keep the permit alive, to conduct an originally permitted activity that was
never conducted, or for some other reason?
Thanks for your help and clarification,
Thomas Slusser, L.G.
Program Manager
Underground Injection Control Program
ph# .919-715-6164
fax# [phone]
DWQ - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.

NCDENR
North Carolina Department o` Environment and
Division of Water Quality
Beverly Paves Perdue Coleen H. Sullins
Governor Director
March 3. 2010
Roy Walker
Gilbarco
7300 West Friendly Avenue
Greensboro. NC 27420
Subject: Acknowledgement of Application No. WI0400091
Gilbarco Incorporated -Guilford
Injection In situ Groundwater Remediation (5I)
Guilford
Dear Mr. Walker:
Natural Resources
Dee Freeman
Secretary
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit application and
supporting materials on February 25, 2010. This application package has been assigned the number listed above and will be reviewed
by Thomas Slusser.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary. To ensure the
maximum efficiency in processing permit applications, the Division requests your. assistance in providing a timely and complete
response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final action by the
Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days after receipt of a complete
application.
If you have any questions, please contact Thomas Slusser at 919-715-6629. or via e-mail at thomas.slusserCa ncdenr.gov. If the
reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division has reorganized. To
review our new organizational chart, go to http:"h2o.enr.state.nc.us/'documents/dwq or2chart.pdf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS PROJECT.
Sincerely,
for Debra J. Watts
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Christopher W. Hay (Kicinfelder Southeast, Inc) 313 Gallimore Dairy Road. Greensboro. NC 27409
Permit Application File WI0400091
AQUIFER PROTE TION SE710N
1E36 Mail Service Center. Raleigr, North Carolina 27E9�- ^-Y
Location. 2728 2amtal Bouevard. Raleigr: North C,aroiina 21' One
Phone [phone] ' FAY 1,.. 91'-715-05BS: FAX 2 919-'15-6048 _-ustome• Service-177-322-6748 NorChCarolina
Interne*.www.ncwateraualty.org oli
l rmalive= ,cin=rnmovr' Naturally

Gilbarco MW-45 info
S"ubjeet: Gilbarco MW-45 info
From: "Hay, Chris" <[e-mail]>
Date: Mon, 24 Mar 2008 14:53:26 -0400
To: <[e-mail]>
MW-45 was completed on 9/11/08. The well is 2 inch diameter pvc, screened from 21 to 36 feet below ground
surface, sand pack from 19 to 36 feet, bentonite from 16 to 19 feet, and neat cement grout from ground surface
to 16 feet. The well has a stick-up well cover.
Thank you,
Christopher W. Hay, E.I.
Trigon Engineering Consultants, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
336.668.0093 office
chay(a-)trigoneng.com email
1 of 1 3/24/2008 2:55 PM

RE: Gilbarco Injection Permit Application (WI0400091)
Subject: RE: Gilbarco Injection Permit Application (WI0400091)
From: "Hay, Chris" <[e-mail]>
Date: Thu, 28 Feb 2008 11:02:33 -0500
To: "Qu Qi" <[e-mail]>
The only opportunity for a gas accumulation would be in the well vault,
but we have taken precautions to ventilate the vaults. Also, if
equipment changes or modifications are necessary, we are planning to
have nitrogen cylinders on -site to purge the lines or any confined
spaces.
Thank you,
Christopher W. Hay, E.I.
Trigon Engineering Consultants, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
336.668.0093 office
[e-mail] email
-----Original Message -----
From: Qu Qi [mailto:[e-mail]]
Sent: Friday, February 22, 2008 7:51 AM
To: Hay, Chris
Subject: Re: Gilbarco Injection Permit Application (WI0400091)
Chris:
Thank you for getting back to me so quickly. The question I have is the
possibility of gas cumulation in some confined space if a preferred
pathway (e.g., a fracture zone or utility pipes, etc.) exists. I think
the proposed system is safe, but I want hear that from you.
Qu Qi
Hay, Chris wrote:
Qu Qi,
I was given a message that you called today with a question about the
treatment technology proposed at Gilbarco. I understand your concern
is that like air sparge the injection system may have the potential to
I"push" contaminants to undesirable locations. The proposed system will
not have this capability because the "injected" gas will not be
released from the well under pressure. There will be approximately 5
to 10 pounds per square inch of pressure from the regulator to the
HiSOC or iSOC unit in the well. This is to push the gas into the well;
Ihowever, the injection wells will not be sealed. The result is that no
pressure will be allowed to build up exiting the well screen. The
HiSOC and iSOC units are designed to release gas at such a small size
as to allow for saturation of dissolved hydrogen or oxygen levels in
the injection wells. The dissolved hydrogen and oxygen will then
travel with the groundwater until depleted. The hydrogen or oxygen
will not be pushed out from the wells under pressure; the dissolved
gas will migrate by the processes controlling groundwater and
contaminant movement (dispersion, dissolution, diffusion). The result
is there should be no concern for forcing contaminant movement by
injecting gas under pressure.
1 of 2 3/20/2008 11:24 AM

RE: Gilbarco Injection Permit Application (WI0400091)
Please let me know if you have any further questions.
Thank you,
Christopher W. Hay, E.I.
Trigon Engineering Consultants, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
336.668.0093 office
[e-mail] <mailto:[e-mail]> email
2 of 2 3/20/2008 11:24 AM

Re: Gilbarco Injection Permit Application (WI0400091)
Subject: Re: Gilbarco Injection Permit Application (WI0400091)
From: Qu Qi <[e-mail]>
Date: Fri, 22 Feb 2008 07:51:22 -0500
To: "Hay, Chris" <[e-mail]>
Chris:
Thank you for getting back to me so quickly. The question I have is the possibility
of gas cumulation in some confined space if a preferred pathway (e.g., a fracture
zone or utility pipes, etc.) exists. I think the proposed system is safe, but I
want hear that from you.
Qu Qi
Hay, Chris wrote:
Qu Qi,
I was given a message that you called today with a question about the treatment
technology proposed at Gilbarco. I understand your concern is that like air
sparge the injection system may have the potential to "push" contaminants to
undesirable locations. The proposed system will not have this capability because
the "injected" gas will not be released from the well under pressure. There will
be approximately 5 to 10 pounds per square inch of pressure from the regulator
to the HiSOC or iSOC unit in the well. This is to push the gas into the well;
however, the injection wells will not be sealed. The result is that no pressure
will be allowed to build up exiting the well screen. The HiSOC and iSOC units
are designed to release gas at such a small size as to allow for saturation of
dissolved hydrogen or oxygen levels in the injection wells. The dissolved
hydrogen and oxygen will then travel with the groundwater until depleted. The
hydrogen or oxygen will not be pushed out from the wells under pressure; the
dissolved gas will migrate by the processes controlling groundwater and
contaminant movement (dispersion, dissolution, diffusion). The result is there
should be no concern for forcing contaminant movement by injecting gas under
pressure.
Please let me know if you have any further questions.
Thank you,
Christopher W. Hay, E.I.
Trigon Engineering Consultants, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
336.668.0093 office
[e-mail] <mailto:[e-mail]> email
u Qi <qu.giPncmail.net>
Underground Injection Control Program Manager
NCDENR
Division of Water Quality
1 of 1 3/20/2008 11:25 AM

Gilbarco Injection Permit Application (WI0400091)
Subject: Gilbarco Injection Permit Application (WI0400091)
From: "Hay, Chris" <[e-mail]>
Date: Thu, 21 Feb 2008 17:40:39 -0500
To: <[e-mail]>
Qu Qi,
I was given a message that you called today with a question about the treatment technology proposed at
Gilbarco. I understand your concern is that like air sparge the injection system may have the potential to "push"
contaminants to undesirable locations. The proposed system will not have this capability because the "injected"
gas will not be released from the well under pressure. There will be approximately 5 to 10 pounds per square
inch of pressure from the regulator to the HiSOC or iSOC unit in the well. This is to push the gas into the well;
however, the injection wells will not be sealed. The result is that no pressure will be allowed to build up exiting
the well screen. The HiSOC and iSOC units are designed to release gas at such a small size as to allow for
saturation of dissolved hydrogen or oxygen levels in the injection wells. The dissolved hydrogen and oxygen will
then travel with the groundwater until depleted. The hydrogen or oxygen will not be pushed out from the wells
under pressure; the dissolved gas will migrate by the processes controlling groundwater and contaminant
movement (dispersion, dissolution, diffusion). The result is there should be no concern for forcing contaminant
movement by injecting gas under pressure.
Please let me know if you have any further questions.
Thank you,
Christopher W. Hay, E.I.
Trigon Engineering Consultants, Inc.
313 Gallimore Dairy Road
Greensboro, North Carolina 27409
336.668.0093 office
chay(a)_trigonenq.com email
1 of 1 3/20/2008 11:24 AM

ENGINEEFdNG CONSULTANTS, INC.
Since
1983
www.trigoneng.com
P.O. Sox 18846 • Zip 27419-8846 • 313 Gallimore Dairy Road • Greensboro, NC 27409 + p 336.668M93 • f 336.668,3868
LETTER OF TRANSMITTAL
TO: Date: 08130 107
Mr. Qu Qi Regular Mail: ✓
Underground Injection Control Program Manager Express Mail:
NCDENR I Division of Water Quality Federal Express:
1636 Mail Service Center Hand Carried:
Aquifer Protection Section Other:
Raleigh, NC 27699-1636
COPIES
DESCRIPTION
I COMMENTS
1
Form UIC-51/5T
Application for Permit to Construction and/or
Use a Well[s] for Injection
Tri on Project No. 042-06-216
-�
C S
SPECIAL INSTRUCTIONS:
SIGNATURE: CL 4- w
Christoph W. Hay, E.I.
Natural Resources Department Mauer ager
A

p�pGF W ATFRQMichael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
O -C Coleen H. Sullins Director
Division of Water Quality
August 30, 2007
Paul Lemmers
Gilbarco, Inc.
7300 West Friendly Avenue
Greensboro, NC 27410
Subject: Acknowledgement of Application No. WI0400091
Gilbarco Incorporated - Guilford
Injection In situ Groundwater Remediation Well (5I)
Guilford
Dear Mr. Lemmers:
The Aquifer Protection Section of the Division of Water Quality (Division) acknowledges receipt of your permit
application and supporting materials on August 29, 2007. This application package has been assigned the number
listed above and will be reviewed by Peter Pozzo.
The reviewer will perform a detailed review and contact you with a request for additional information if necessary.
To ensure the maximum efficiency in processing permit applications, the Division requests your assistance in
providing a timely and complete response to any additional information requests.
Please be aware that the Division's Regional Office, copied below, must provide recommendations prior to final
action by the Division. Please also note at this time, processing permit applications can take as long as 60 - 90 days
after receipt of a complete application.
If you have any questions, please contact Peter Pozzo at 919-715-6164, or via e-mail at [e-mail]. If
the reviewer is unavailable, you may leave a message, and they will respond promptly. Also note that the Division
has reorganized. To review our new organizational chart, go to
http://h2o.enr.state.nc.us/documents/dwq orgchart.ydf.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRIES ON THIS
PROJECT.
Since
for Debra . W s
Supervisor
cc: Winston-Salem Regional Office, Aquifer Protection Section
Christopher Hay, El, Trigon engineering Consultants, Inc.
Permit Application File WI0400091
Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636
Internet: www.ncwaterouality.org Location: 2728 Capital Boulevard Raleigh, NC 27604
An Equal Opportunity/Affirmative Action Employer- 50% Recycled/10% Post Consumer Paper
NpnrthCarolina
,Naturally
Telephone: [phone]
Fax1: [phone]
Fax 2: [phone]
Customer Service: [phone]

ENGINEERINQ CONSULTANTS, INC.
Since
1983
www.trigoneno.com
P.G. Box 18846 • Zip 27419-8846 • 313 Gallimore Dairy Road • Greensboro. NC 27409 • p 336.668,0093 • f 336.668.3868
August 28, 2007
Mr. Peter Pozzo
UIC Program
Aquifer Protection Section
North Carolina DENR — DWQ
1636 Mail Service Center
Raleigh, NC 27699-1636
Reference: UIC Permit Application
Hydrogen and Oxygen Delivery System
Gilbarco
7300 West Friendly Avenue
Greensboro, North Carolina
Trigon Project No. 042-06-216
Dear Mr. Pozzo:
Trigon Engineering Consultants, Inc. (Trigon) is pleased to provide this Underground Injection Control
(UIC) Permit Application for treatment of groundwater with a subsurface hydrogen and oxygen delivery
system at the referenced site. Two copies of the permit application have been enclosed for your review.
Should you have any questions or require additional information, please do not hesitate to contact Chris
Hay at your convenience.
Very truly yours,
TRIGON ENGINEERING CONSULTANTS, INC.
.�%OAAn
Gail G. Licayan, P.E. Christopher W. Hay E I.
Project Manager Natural Resources D artment Manager
GGL/CWH:cas
sA420)projects120W216 (remedial action plan luic permit application.doc
lk,�,u1,.r.,ur

I
WQROS REGIONAL STAFF REPORT
DW: May 14, 2015 County: Guilford
To: Thomas Slusser, WQROS-Groundwater Protection Branch Permittee: Gilbarco
Central Office Reviewer: Project Name: Gilbarco, Inc.
Regional Login No: Application No.: W0400091
L GENERAL INFORMATTON
1. This application is (check all that apply): ❑ New ® Renewal
❑ Minor Modification ❑ Major Modification
Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® (41er Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? [A'Yes or ❑ No.
a. Date of site visit: ray 13, 2015
b. Person contacted and contact information: JoiwBuike, Gilbarco Inc., 336-547-5827 and Chris Hay,
Enkirotrac, 336-763-6025
c. Site visit conducted by: Jjg1AConsie►vski and Shuying Wang_
d. Inspection Report Attached: ❑ Yes or J No.
2. Is the following information entered into the BIMS record for this application correct?
R -1'es or ❑ No. If no, please complete the following or indicate that it is correct on the current application.
For Treatment Facilities:
a. Location (s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude:
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For Disposal and Infection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site
a. Location(s):
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: __ Longitude:
IL NEW AND MAJOR MODIFICATIONAPPLICATIONS (this section not needed for renewals or minor
modifications, ski to next section)
Description Of WastefS) And Facilities

WQROS REGIONAL STAFF REPORT
1. Please attach completed rating sheet. Facility Classification:
2. Are the new treatment facilities adequate for the type of waste and disposal system?
❑ Yes ❑ No ❑ N/A. If no, please explain:
3. Are the new site conditions (soils, topography, depth to water table, etc) consistent with what was reported by
the soil scientist and/or Professional Engineer? ❑ Yes ❑ No ❑ N/A. If no, please explain:
4. Does the application (maps, plans, etc.) represent the actual site (property lines, wells, surface drainage)? ❑
Yes ❑ No ❑ N/A. If no, please explain:
5. Is the proposed residuals management plan adequate and/or acceptable to the Division. ❑ Yes ❑ No ❑
N/A. If no, please explain:
6. Are the proposed application rates for new sites (hydraulic or nutrient) acceptable?
❑ Yes ❑ No ❑ N/A. If no, please explain:
7. Are the new treatment facilities or any new disposal sites located in a 100-year floodplain?
❑ Yes ❑ No ❑ N/A. If yes, please attach a map showing areas of 100-year floodplain and please explain
and recommend any mitigative measures/special conditions in Part IV:
8. Are there any buffer conflicts (new treatment facilities or new disposal sites)? ❑ Yes or ❑ No. If yes, please
attach a map showing conflict areas or attach any new maps you have received from the applicant to be
incorporated into the permit:
9. Is proposed and/or existing groundwater monitoring program (number of wells, frequency of monitoring,
monitoring parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well
network if applicable. Indicate the review and compliance boundaries. If No, explain and recommend any
changes to the groundwater monitoring program:
10. For residuals, will seasonal or other restrictions be required? ❑ Yes ❑ No ❑ N/A If yes, attach list of sites
with restrictions (Certification B?)
M. RENEWAL AND MODIFICATIONAPPLICATIONS (use previous section for new or maior modiluation
system)
Description Of Waste(S) And Facilities (THIS SECTION MODWWD TO INCLUDE APPLICABLE OTNS)
1. Is the existing groundwater monitoring program (number of wells, frequency of monitoring, monitoring
parameters, etc.) adequate? ❑ Yes ❑ No ❑ N/A. Attach map of existing monitoring well network if
applicable. Indicate the review and compliance boundaries. If No, explain and recommend any changes to the
groundwater monitoring program:
2. Is the description of the facilities, type and/or volume of waste(s) as written in the existing permit correct? ❑
Yes or ❑ No. If no, please explain:
2

rJ
WQROS REGIONAL STAFF REPORT
3. Were monitoring wells properly constructed and located? ❑ Yes or ❑ No ❑ N/A. If no, please explain:
4. Has a review of all self -monitoring data been conducted (GW, NDMR, and NDAR as applicable)? ❑ Yes or
❑ No ❑ N/A. Please summarize any findings resulting from this review:
5. Check all that apply: ❑ No compliance issues; ❑ Notice(s) of violation within the last permit cycle; ❑
Current enforcement action(s) ❑ Currently under SOC; ❑ Currently under JOC; ❑ Currently under
moratorium. If any items checked, please explain and attach any documents that may help clarify
answer/comments (such as NOV, NOD etc):
6. Have all compliance dates/conditions in the existing permit, (SOC, JOC, etc.) been complied with? ❑ Yes
❑ No ❑ Not Determined ❑ N/A.. If no, please explain:
7. Are there any issues related to compliance/enforcement that should be resolved before issuing this permit? ❑
Yes or ❑ No ❑ N/A. If yes, please explain:
IV. INJECTION WELL PERMITAPPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description Of Well(S) And Facilities — New, Renewal, And Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
® jusiL .remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5U Non -Discharge")
❑ Other (Specify:
2. Does system use same well for water source and injection? ❑ Yes Awe.
3. Are there any potential pollution sources that may affect injection? D&Yas ❑ No
What is/are the pollution source(s)? What is the distance of the injection well(s) from the pollution source(s)?
P ase see Aygwt 20 2012 Re ionaISt re .pqrt
4. What is the minimum distance of proposed injection wells from the property boundary? 200 feet
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
6. Flooding potential of site: ❑ Low M=Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? WMmEl No Attach map
of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater -monitoring program:
3

WQROS REGIONAL STAFF REPORT
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? [J.Yes or ❑ No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Iniection Well Permit Renewal And Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
❑ Yes ❑ No. If yes, explain:
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of any type), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident?❑ Yes @gNo. If yes, explain.
4. Drilling contractor: Name:
Address:
Certification number:
Complete and attach Well Construction Data Sheet.
V. EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the application
2. -Attach Well Construction Data Sheet - if needed information is available
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly_
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
4

r
WQROS REGIONAL STAFF REPORT
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional informations;
Lw*M- ❑ Deny. If deny, please state reasons:
8. Signature of report preparer(s):
Signature of APS regional supervisor: Y-
Date: ) S�
ADDITIONAL REGIONAL STAFF REVIEW ITEMS
5

WATER QUALITY REGIONAL OPERATIONS SECTION
APPLICATION REVIEW REQUEST FORM
Date: April 15, 2015
To: WSRO-WQROS: Corey Basinger / Sherri Knight
From: Thomas Slusser, WQROS — Groundwater Protection Branch
Telephone. [phone] Faati [phone] E Maik [e-mail]
A. Permit Number: W10400091
B. Applicant: Gilbarco
C. Facility Name: Gilbarco-Veeder-Root, 7300 West Friendly Avenue
D. Application:
PermU Type: Groundwater Remediation Well
Project 4pe: Renewal
E. Comments/Other Information: no modification, iust renewal of permit
❑ I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please return a completed WOROS Staff
Report.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office Groundwater Protection Branch contact
person listed above.
RO-WOROS Reviewer: '�Y
-� /s
9
FORM: WQROSARR-GW Protection Branch 050914 Page 1 of 1

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: August 8, 2012
To: ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO-APS ❑ Morella King, WiRO-APS
❑ Andrew Pitner, MRO-APS �'pfyt�; X Sherri Knight, WSRO-APS
❑ Jay Zimmerman, RRO-APS
avid Goodrich , Land Application Unit
Telephone: [phone] Fax: [phone]
E-Mail. david,goodrich(kncdenr.gov
A. Permit Number: WI0400091 RECEIVED1DENOW0
B. Owner: Gilbarco, Inc. AUG 2 7 2012
C. Facility/Operation: Gilbarco Incorporated - Guilford Facility Aquifer Protection Section
X Proposed ❑ Existing X Facility X Operation
D. Application:
I. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon X GW Remediation (ND) 5I Inj. wells
❑ UIC - (5A7) open loop geothermal
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: []New X Major Mod. ❑ Minor Mod. F 1 Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: F1 I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
X Return a Completed APSARR Form. - Please comment
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO.*
* Remember that you will be responsible for coordinating site visits and reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer: ti�� �% Date: i v 1
FORM: APSARR 07/06
Page 1 of 1

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
Date: Aueust 20, 2012
To: APS Central Office
Central Office Reviewer: David Goodrich
Regional Login No:
Permittee(s): Gibarco, Inc
Permit No.: WI0400091
County: Guilford
Project Name: Gilbarco Inc. — Guilford Facility
L GENERAL INFORMATION
1. This application is (check all that apply): ❑ SFR Waste Irrigation System ® UIC Well(s)
❑ New ® Renewal
❑ Minor Modification ® Major Modification
RECEIVEDIDENRIDWQ
AUG 2 7 m2
Aquifer Protection SWi0rl
❑ Surface Irrigation ❑ Reuse ❑ Recycle ❑ High Rate Infiltration ❑ Evaporation/Infiltration Lagoon
❑ Land Application of Residuals ❑ Attachment B included ❑ 503 regulated ❑ 503 exempt
❑ Distribution of Residuals ❑ Surface Disposal
❑ Closed -loop Groundwater Remediation ® Other Injection Wells (including in situ remediation)
Was a site visit conducted in order to prepare this report? ® Yes or ❑ No.
a. Date of site visit: 8/17/2012
b. Person contacted and contact information: Chris Hay, Kleinfelder Southeast, Inc., 336-668-0093, Ext. 113
c. Site visit conducted by: Shuying Wang
d. Inspection Report Attached: ❑ Yes or ® No.
2. Is the following information entered into the BIMS record for this application correct?
❑ Yes or ® No. If no, please complete the following or indicate that it is correct on the current application.
For SFR Treatment Facilities:
a. Location:
b. Driving Directions:
c. USGS Quadrangle Map name and number:
d. Latitude: Longitude: Method Used (GPS, GoogleTM, etc.);
e. Regulated Activities / Type of Wastes (e.g., subdivision, food processing, municipal wastewater):
For UIC Injection Sites:
(If multiple sites either indicate which sites the information applies to, copy and paste a new section into the
document for each site, or attach additional pages for each site)
a. Location(s): 7300 West Friendly Avenue, Greensboro, NC
b. Driving Directions:
c. USGS Quadrangle Map name and number: Guilford 36079-A8-TF-024
d. Latitude: Longitude: Method Used (GPS, GoogleTM, etc.);
APS-GPU Regional Staff Report (Sept 09) Page 1 of 6 Pages

'AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
IV. INJECTION WELL PERMIT APPLICATIONS (Complete these two sections for all systems that use injection
wells, including closed -loop groundwater remediation effluent injection wells, in situ remediation injection wells, and heat
pump injection wells.)
Description of Well(s) and Facilities — New, Renewal, and Modification
1. Type of injection system:
❑ Heating/cooling water return flow (5A7)
❑ Closed -loop heat pump system (5QM/5QW)
® In situ remediation (5I)
❑ Closed -loop groundwater remediation effluent injection (5L/"Non-Discharge")
❑ Other (Specify:
2. Does system use same well for water source and injection? ❑ Yes ® No
3. Are there any potential pollution sources that may affect injection? ® Yes ❑ No
What is/are the pollution source(s)? Petroleum storage tanks with containment. What is the distance of the
injection well(s) from the pollution source(s)? Within the plum.
4. What is the minimum distance of proposed injection wells from the property boundary? 200 ft.
5. Quality of drainage at site: ❑ Good ® Adequate ❑ Poor
6. Flooding potential of site: ❑ Low ® Moderate ❑ High
7. For groundwater remediation systems, is the proposed and/or existing groundwater monitoring program
(number of wells, frequency of monitoring, monitoring parameters, etc.) adequate? ® Yes ❑ No. Attach
map of existing monitoring well network if applicable. If No, explain and recommend any changes to the
groundwater monitoring program:
8. Does the map presented represent the actual site (property lines, wells, surface drainage)? ® Yes or ❑ No. If
no or no map, please attach a sketch of the site. Show property boundaries, buildings, wells, potential pollution
sources, roads, approximate scale, and north arrow.
Injection Well Permit Renewal and Modification Only:
1. For heat pump systems, are there any abnormalities in heat pump or injection well operation (e.g. turbid water,
failure to assimilate injected fluid, poor heating/cooling)?
❑ Yes ❑ No. If yes, plain:
2. For closed -loop heat pump systems, has system lost pressure or required make-up fluid since permit issuance
or last inspection? ❑ Yes ❑ No. If yes, explain:
3. For renewal or modification of groundwater remediation permits (of any lype), will
continued/additional/modified injections have an adverse impact on migration of the plume or management of
the contamination incident? ❑ Yes ® No. If yes, explain:
APS-GPU Regional Staff Report (Sept 09) Page 4 of 6 Pages

'AQUIFER PROTECTION SIECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
4. Drilling Contractor: Name: Ronald Toothman
Address: 510 Industrial Avenue, Greensboro, NC 27406
NC Certification number: 2075
5. Complete and attach NEW Injection Facility Inspection Report, if applicable
V EVALUATIONAND RECOMMENDATIONS
1. Provide any additional narrative regarding your review of the Application:
2. Attach new Injection Facility Inspection Form, if applicable
3. Do you foresee any problems with issuance/renewal of this permit? ❑ Yes ® No. If yes, please explain
briefly.
4. List any items that you would like APS Central Office to obtain through an additional information request.
Make sure that you provide a reason for each item:
Item Reason
5. List specific Permit conditions that you recommend to be removed from the permit when issued. Make sure
that you provide a reason for each condition:
Condition Reason
6. List specific special conditions or compliance schedules that you recommend to be included in the permit when
issued. Make sure that you provide a reason for each special condition:
Condition Reason
APS-GPU Regional Staff Report (Sept 09) Page 5 of 6 Pages

AQUIFER PROTECTION SECTION - GROUNDWATER PROTECTION UNIT
REGIONAL STAFF REPORT
7. Recommendation: ❑ Hold, pending receipt and review of additional information by regional office; ❑ Hold,
pending review of draft permit by regional office; ❑ Issue upon receipt of needed additional information;
Issue; ❑ Deny. If deny, please state reasons:
8. Signature of report Preparer(s):
Signature of APS regional supervisor:
Date:
b
�v,.. yY . 1�.,_ AN
VI. ADDITIONAL INFORMATIONAND SITE MAP (Sketch of site showing house and waste irrigation
system, spray or drip field, location of well(s), and/or other relevant information- SHOW NORTHARROW)
APS-GPU Regional Staff Report (Sept 09) Page 6 of 6 Pages

Central Files: APS SWP
08/08/12
Permit Number W10400091 Permit Tracking Slip
Program Category Status Project Type
Ground Water In review Major modification
Permit Type Version Permit Classification
Injection In situ Groundwater Remediation Well Individual
Primary Reviewer Permit Contact Affiliation
david.goodrich Christopher Hay
Environmental Group Manager
Coastal SW Rule 313 Gallimore Dairy Rd
Greensboro NC 274099724
Permitted Flow
Facility
Facility Name Major/Minor Region
Gilbarco Incorporated -Guilford Minor Winston-Salem
Location Address County
PO Box 22087 Guilford
Greensboro NC 274202087 Facility Contact Affiliation
Owner
Owner Name Owner Type
Gilbarco Inc Non -Government
Owner Affiliation
Roy Walker
7300 W Friendly Ave
Dates/Events Greensboro NC 274202087
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
03/20/08 08/06/12
Regulated Activities Requested/Received Events
Groundwater remediation RO staff report received
RO staff report requested
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

North Carolina Department of Health and Human Services
Division of Public Health • Epidemiology Section
1912 Mail Service Center • Raleigh, North Carolina 27699-1912
Tel [phone] • Fax [phone]
Michael F. Easley, Governor
January 17, 2007
MEMORANDUM
TO: Qu Qi
Underground Injection Control Program
Aquifer Protection Section
a
FROM: Luanne K. Williams, Pharm.D., Toxicologist
Medical Evaluation and Risk Assessment Unit
Occupational and Environmental Epidemiology Branch
North Carolina Department of Health and Human Services
Carmen Hooker Odom, Secretary
SUBJECT: Use of Non -Biological Product by Regenesis to Enhance Biodegradation
of Contaminated Groundwater
I am writing in response to a request for a health risk evaluation regarding the use
of a non -biological product by Regenesis to enhance biodegradation of contaminated
groundwater. Based upon my review of the information submitted, I offer the following
health risk evaluation:
Ingestion may result in burns to the lips, tongue, and mouth. Exposure to
the eyes can cause distortion of cellar membranes, loss of corneal,
conjunctival and lens epithelium and loss of endothelium of the cornea
and blood vessels. Inhalation may produce upper airway edema,
respiratory failure, wheezing, pulmonary edema, and pneumonitis. Skin
exposure may cause pain, redness, irritation and severe burns
(Micromedex TOMES Plus System CD-ROM Database, Volume 71,
2007).
c%J
c�' 2. If the products are released into the environment in a way that could result
`') in a suspension of fine solid or liquid particles (e.g., grinding, blending,
c vigorous shaking or mixing), then proper personal protective equipment
_ should be used. The application process should be reviewed by an
industrial hygienist to ensure that the most appropriate personal protective
equipment is used.
CD 3. Persons working with this product should at least wear goggles or a face
shield, gloves, and protective clothing. Face and body protection should
® Location: 5505 Six Forks Road, 2" Floor, Room D1 • Raleigh, N.C. 27609 An Equal Opportunity Employer

be used for anticipated splashes or sprays. Again, consult with an
industrial hygienist to ensure proper protection.
4. Eating, drinking, smoking, handling contact lenses, and applying
cosmetics should never be permitted in the application area during or
immediately following application. Safety controls should be in place to
ensure that the check valve and the pressure delivery systems are working
properly.
5. The Material Safety Data Sheets should be followed to prevent adverse
reactions and injuries.
6. Access to the area of application should be limited to the workers applying
the product. In order to minimize exposure to unprotected individuals,
measures should be taken to prevent access to the area of application.
Violent reactions or ignition could occur under the appropriate conditions
with acids, alcohols, p-bis (1, 3-dibromoethyl) benzene, cyclopentadiene,
germanium, hyponitrous acid, maleic anhydride, nitroalkanes, 2-
nitrophenol, potassium peroxodisulfate, sugars, 2, 2, 3, 3-
tetrafluoropropanol, and thorium dicarbide. Measures should be taken to
prevent such reactions (Micromedex TOMES Plus System CD-ROM
Database, Volume 71, 2007).
8. Measures should be taken to prevent contamination of existing or future
wells and surface waters that may be located near the application area.
Please do not hesitate to call me if you have any questions at [phone].
CV
- C"
cl-
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SUPPORTING MATERIALS
PERMIT REISSUANCE
OF
APRI L 20, 2010

Slusser, Thomas
From:
Wang, Shuying
Sent:
Tuesday, April 06, 2010 4:45 PM
To:
Slusser, Thomas
Cc:
Knight, Sherri
Subject:
Application Renewal - W 10400091, Guilford
Hi Thomas,
I have contacted Gene Mao, the incident manager in Guilford County, who oversees site activities, regarding the site
conditions and injection activities. In addition, I have carefully reviewed the latest quarter monitoring report. Based on
the information provided by Gene Mao and documented in Quarterly HiSOC Monitoring Report dated January 4, 2010, 1
determine that the operation and monitoring of the injection of hydrogen gas at the site appear to have been
performed in accordance with requirements set in the permit. No negative impact of injection activities on groundwater
or other complaints regarding rejection activities have been received or documented since the permit was issued.
Groundwater sampling results show concentrations of total chlorinated hydrocarbons has been generally decreasing
since the injection started. Other conditions of the site have no change. Therefore, WSRO recommends renew the
permit.
If you have any questions regarding the site condition or this email, please call or email me.
Shuying Wang
Hydrogeologist
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone] or 771-4632
****************
E-mail correspondence to and from this address may be subject to
the North Carolina Public Records Law and may be disclosed to third parties.
****************

WQ0006751 and WI0400091
Subject: WQ0006751 and WI0400091
From: Qu Qi <[e-mail]>
Date: Thu, 21 Feb 2008 16:18:56 -0500
To: Sherri Knight <[e-mail]>
Hi, Sherri,
Debra wants to send this permit (WQ0006751) out asap. If there is any problem with
the reporting or monitoring, we can issue an NOV instead of holding the permit up
in the house. If you don't have any heart -burn issues with this renewal (modified
version issued only one year ago), I'm going to send this one out soon.
WI0400091 permit application was received in August 2007 and we really need to make
a decision on this one too (by 3/31/2008, it will be more than 180 days since we
received it). The only concern I have about this one is that if a short circuit
formed underground, then there is a potential to have these gases (H2 and 02)
cumulating somewhere in a confined space. That could be bad. However, the
concentrations of H2 and 02 at the injection points are very low, 1 to 4 ppm for H2
and 50 to 90 ppm for 02, so eve if these gases escaped and cumulated somewhere, it
probably will not cause problem. I have asked TRIGON to provide some assurance
that this system is safe. I will share with you what they tell me.
Thanks!
-------- Original Message --------
Subject: [Fwd: Highland GW-59s]
Date: Thu, 14 Feb 2008 15:56:46 -0500
From: Qu Qi <[e-mail]>
Organization: NCDENR-DWQ-APS
To: Sherri Knight <Sherri.Knightcwncmail.net>
Sherri:
Here is the GW-59 for Highland Industries WQ0006751; I think they re -activated the
system not long ago. They modified the permit about a year ago and now it needs to
be renewed. Let me know if you need more info on this one. Thanks!
Qu
-------- Original Message --------
Subject: Highland GW-59s
Date: Thu, 14 Feb 2008 15:51:18 -0500
From: Phil Rahn <[e-mail]>
Organization: Waters Edge Environmental, LLC
To: <[e-mail]>
Qu,
Here is electronic copy of GW-59s from May 2007 when we engaged system and January
2008. We were having some O&M problems in October, therefore were unable to
sample. Due to the elevated effluent results in January, we are doing some
trouble -shooting and will resample. I will forward hard copy to you shortly. I
was also wondering about the new permit in that the old permit expires at the end
of February. Is new permit going to be out shortly?
Phillip L. Rahn P.G.
1 of 2 3/24/2008 2:55 PM

WQ0006751 and WI0400091
President
Waters Edge Environmental
4901 Waters Edge Drive, Suite 201
Raleigh, NC 27608
919.859.9987 (office)
919.219.5820 (cell)
919.859.9930 (fax)
prahn®watersedgeenv.com<mailto: prahn®watersedgeenv.com> (E-mail)
u Qi <qu.gi(ancmail.net>
Underground Injection Control Program Manager
NCDENR
Division of Water Quality
[08-131 (GW-59 for May 2007 Sampling).DOC Content -Type: application/msword
Content -Encoding: base64
08-131 (GW-59).DOC /m Content -Type: applicationsword
Content -Encoding: base64
2 of 2 3/24/2008 2:55 PM

W 10400091
Subject: WI0400091
From: Qu Qi <[e-mail]>
Date: Mon, 19 Nov 2007 11:44:29 -0500
To: Sherri Knight <[e-mail]>
Hi, Sherri,
Peter is leaving and I'm taking up all the permits he has been working on. I'm
wounding if you have the package for WI0400091- Gilbarco; it was sent to WSRO on
9/17/2007. Please give me an update on it. Thanks! Qu
u Qi <qu.gi a,ncmai1.net>
Underground Injection Control Program Manager
NCDENR
Division of Water Quality
1 of 1 11/19/2007 11:44 AM

Re: WI0400091
Subject: Re: WI0400091
From: Qu Qi <[e-mail]>
Date: Mon, 19 Nov 2007 12:56:52 -0500
To: [e-mail]
Thanks! Peter is leaving by the end of this week. Qu
Sherri Knight wrote:
I had given this to Chris Greene to work out a review with Peter. Chris hasn't
been reviewing these injection permits so he isn't familiar with them. I guess
we can't do that now since Peter is leaving (already gone?) I have sent a
request for info to Gene Mao who is the incident manager in Guilford. He and I
should be able to sent up comments fairly soon. Probably won't be this week
unless Gene just happens to be free in the next day or so.
Sherri Knight, PE
NC DENR Winston-Salem Regional Office
Division of Water Quality, Aquifer Protection Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
On 11/19/2007 11:44 AM, Qu Qi wrote:
Hi, Sherri,
Peter is leaving and I'm taking up all the permits he has been working on.
I'm wounding if you have the package for WI0400091- Gilbarco; it was sent to
WSRO on 9/17/2007. Please give me an update on it. Thanks! Qu
u Qi <qu.giPncmai1.net>
Underground Injection Control Program Manager
NCDENR
Division of Water Quality
1 of 1 3/24/2008 2:55 PM

AQUIFER PROTECTION SECTION
APPLICATION REVIEW REQUEST FORM
Date: September 17, 2007
To: ❑ Landon Davidson, ARO-APS ❑ David May, WaRO-APS
❑ Art Barnhardt, FRO-APS ❑ Charlie Stehman, WiRO-APS
❑ Andrew Pitner, MRO-APS ® Sherri Knight, WSRO-APS
❑ Jay Zimmerman, RRO-APS
From: Peter Poczo , Groundwater Protection Unit
Telephone: [phone] Fax: [phone]
E-Mail: peter.pozzo(a ncmail.net
A. Permit Number: WI0400091
B. Owner: Gilbarco
C. Facility/Operation: Gilbarco
® Proposed ❑ Existing ❑ Facility ❑ Operation
D. Application:
1. Permit Type: ❑ Animal ❑ Surface Irrigation ❑ Reuse ❑ H-R Infiltration
❑ Recycle ❑ I/E Lagoon ❑ GW Remediation (ND)
® UIC - (5I) in -situ groundwater remediation H2 and 02
For Residuals: ❑ Land App. ❑ D&M ❑ Surface Disposal
❑ 503 ❑ 503 Exempt ❑ Animal
2. Project Type: ® New ❑ Major Mod. ❑ Minor Mod. ❑ Renewal ❑ Renewal w/ Mod.
E. Comments/Other Information: ® I would like to accompany you on a site visit.
Attached, you will find all information submitted in support of the above -referenced application for your
review, comment, and/or action. Within 30 calendar days, please take the following actions:
® Return a Completed Form APSARR.
❑ Attach Well Construction Data Sheet.
❑ Attach Attachment B for Certification by the LAPCU.
❑ Issue an Attachment B Certification from the RO*.
* Remember that you will be responsible for coordinating site visits, reviews, as well as additional
information requests with other RO-APS representatives in order to prepare a complete Attachment B for
certification. Refer to the RPP SOP for additional detail.
When you receive this request form, please write your name and dates in the spaces below, make a copy
of this sheet, and return it to the appropriate Central Office -Aquifer Protection Section contact person
listed above.
RO-APS Reviewer:
Date:
FORM: APSARR 02/06 Page 1 of 1

North Carolina Department of Health and Human Services
Division of Public Health • Epidemiology Section
1912 Mail Service Center • Raleigh, North Carolina 27699-1912
Tel [phone] • Fax [phone]
Michael F. Easley, Governor
May 21, 2002
MEMORANDUM
TO: Evan Kane
Groundwater Section
FROM: Luanne K. Williams, Pharm.D., Toxicologist
Medical Evaluation and Risk Assessment Unit
Occupational and Environmental Epidemiology Branch
North Carolina Department of Health and Human Services
Carmen Hooker Odom, Secretary
SUBJECT: Use of Oxygen to Enhance Bioremediation of Petroleum Groundwater Contaminants at a
Defense Department Facility in Hertford, North Carolina
I am writing in response to a request for a health risk evaluation regarding the use of oxygen to
enhance bioremediation of petroleum groundwater contaminants at a Defense Department facility in
Hertford, North Carolina. Based upon my review of the information submitted, I offer the following
health risk evaluation:
WORKER PRECAUTIONS DURING APPLICATION
Some effects reported to be associated with short-term exposure to 100% oxygen are as follo% s:
Inhalation of 100% oxygen can result in nausea, dizziness, pulmonary irritation leading to
pulmonary edema, and pneumonitis (Meditext — Medical Management by Micromedex
TOMES Plus System CD-ROM Database, Volume 52, 2002).
Intense and potentially fatal pulmonary edema may develop tracheal irritation, fever, nausea,
vomiting, acute bronchitis, sinusitis, malaise, paresthesias and conjunctivitis (Meditext —
Medical Management by Micromedex TOMES Plus System CD-ROM Database, Volume 52,
2002).
Inhalation of 100% oxygen can cause eye, nose, and throat irritation (Meditext — Medical
Management by Micromedex TOMES Plus System CD-ROM Database, Volume 52, 2002).
The application process should be reviewed by an industrial hygienist to ensure that the most
appropriate personal protective equipment is used.
® Location: 2728 Capital Boidevard • Parker Lincoln Building • Raleigh, N.C. 27604 An EgiW Upponumiy Emplo

Evan Kane Memo
May 21, 2002
Page Two
Eating, drinking, smoking, handling contact lenses, and applying cosmetics should never be
permitted in the application area during or immediately following application.
4. Safety controls should be in place to ensure that the check valve and the pressure delivery
systems are working properly.
The Material Safety Data Sheets should be followed to prevent adverse reactions and injuries.
OTHER PRECAUTIONS
Access to the area of application should be limited to the workers applying the product. In order
to minimize exposure to unprotected individuals, measures should be taken to prevent'access to
the area of application.
According to the information submitted by ATC Associates, the base operates their own public
water system. The active wells are located 1,250 to 1,800 feet northwest of the injection site.
Efforts should be made to prevent contamination of existing or future wells that may be located
near the application area.
According to the information submitted by ATC Associates, there is an unnamed swamp located
approximately 1,000 feet south of the injection site. Because of the proximity to this water body.
measures should be taken to prevent adverse impact to this surface water body.
Please do not hesitate to call me if you have any questions at [phone].
cc: Mr. Wade Jordan, Ph.D.
Harvey Point Defense Testing Activity
2835 Harvey Point Road
Hertford, North Carolina 27944
Mr. Joseph Olinger
ATC Associates of North Carolina, P.C.
6512 Falls of Neuse Road
Raleigh, North Carolina 27615
Air Products & Chemicals, Inc.
7201 Hamilton Boulevard
Allentown, PA 18195-1501

North Carolina Department of Health and Human Services
Division of Public Health • Epidemiology Section
1912 Mail Service Center • Raleigh, North Carolina 27699-1912
Tel [phone] Fax [phone]
hfiduel F. Easley, Governor
October 28, 2003
MEMORANDUM
TO: Evan Kane
Groundwater Section
Carmen Hooker Odon�Secretary
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FROM: Luanne K. Williams, Pharm.D., Toxicologist 4X�1,�
Medical Evaluation and Risk Assessment Unit
Occupational and Environmental Epidemiology Branch
North Carolina Department of Health and Human Services
SUBJECT: Use of Hydrogen and Helium for Bioremediatioin of Chlorinated Solvent
Contaminated Groundwater at the Maintenance Complex for Amphibious
Vehicles at Camp Lejeune Marine Corps Base in Camp Lejeune, North
Carolina.
I am writing in response to a request for a health risk evaluation regarding the use
of hydrogen and helium for bioremediatioin of chlorinated solvent contaminated
groundwater at the maintenance complex for amphibious vehicles at Camp Lejeune
Marine Corps Base in Camp Lejeune, North Carolina. Based upon my review of the
information submitted, I offer the following health risk evaluation:
WORKER PRECAUTIONS DURING APPLICATION
Some effects reported to be associated with the chemicals present in the product
following short-term exposure are as follows:
• Skin contact with helium or hydrogen can cause severe burns and frostbite to
the skin (Hazardous Substance Fact Sheet by Micromedex TOMEs Plus
System CD-ROM Database, Volume 58, 2003).
• Significant inhalation exposure to helium or hydrogen can cause suffocation
from lack of oxygen. Symptoms include dizziness, weakness, nausea,
vomiting, loss of coordination and judgment, increased breathing rate, and
loss of consciousnes and death (Hazardous Substance Fact Sheet by
Micromedex TOMEs Plus System CD-ROM Database, Volume 58, 2003).
2. Hydrogen is a highly flammable liquid or gas and a dangerous fire and explosion
hazard. Hydrogen must be stored to avoid contact with heat, flames, sparks,
1 of 3
® Location: 2728 Capital Boulevard 9 Parker Linwla Building • Raleigh, N.C. 27604 An Equal Opportunity Employer

oxidizing agents (e.g., perchlorates, peroxides, permanganates, chlorates, nitrates,
and bromine), explosives, liquid nitrogen, ozone, palladium, catalysts, lithium,
strontium, barium, and calcium since violent explosions may occur (Hazardous
Substances Data Bank by Micromedex TOMEs Plus System CD-ROM Database,
Volume 58, 2003).
In order to reduce the risk of injury, certain precautions should be followed when
applying the product:
(a) If the product is released into the environment in a way that should result
in a suspension of fine solid or liquid particles (e.g., grinding, blending,
vigorous shaking or mixing, or opening of a container where the internal
pressure may be different from ambient pressure), then proper respiratory
protection should be worn. The application process should be reviewed
by an industrial hygienist to ensure that the most appropriate
respiratory equipment is worn if needed.
(b) Persons working with this product should wear goggles or a face shield,
gloves, and protective clothing. In order to prevent contamination of the
worker's home and other work areas, the gloves and protective clothing
should only be worn in the application area and should never be taken
home.
(c) Eating, drinking, smoking, handling contact lenses, and applying
cosmetics should not be permitted in the application area during or
immediately following application.
(d) Workers should wash their hands after applying the product.
4. Safety controls should be in place to ensure that the check valve and the pressure
delivery systems are working properly.
5. The Material Safety Data Sheets should be followed to prevent adverse reactions
and injuries.
OTHER PRECAUTIONS
Access to the area of application should be limited to the workers applying the
product. In order to minimize exposure to unprotected individuals, measures
should be taken to prevent access to the area of application.
2. Because of the toxicity associated with the chemicals listed in this product,
measures should be taken to prevent contamination to groundwater or surface
water beyond the injection or remediation area.
2of3

In order to minimize risk to the residents that may live near the application area,
measures should be taken to limit access to the area of application to workers
applying the product. In addition, measures should be taken to prevent the
product from being dispersed in the air or released on the ground outside the
application area.
Please do not hesitate to call me if you have any questions at [phone].
LW:pw
cc: Randy McElveen, NC Groundwater Section
Mr. Rick Raines, IR Program Director
Camp Lejeune, Commanding General PCS-EMD
Building 58, PSC Box 20004, Marine Corps Base
Camp Lej eune, NC 28542-004
Mr. Richard E. Bonelli
Michael Baker Jr., Inc., Airside Business Park,
100 Airside Drive
Moon Township, PA 15108
3 of 3

_ A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild , P.E. Dee Freeman
Governor Director Secretary
August 20, 2012
CERTIFIED MAIL: 7008 3230 0003 2547 0336
RETURN RECEIPT REQUESTED
Mr. Roy Walker
Gilbarco, Inc
7300 West Friendly Avenue
Greensboro, NC 27420 RECEIYCMCNRID11Q
Subject: Underground Injection Wells — WI0400091 AUG 2 7 20".
Gilbarco, Inc.
7300 West Friendly Ave., Greensboro, NC Aqur%rPrOle0on 58Gtip�t
Guilford County
Dear Mr. Walker:
As part of the review of an application for Major Modification of Injection Permit WI0400091, on
August 17, 2012, a staff member of the Aquifer Protection Section (APS) Winston-Salem Regional
Office inspected the injection well system at the subject location. Ten injection wells were constructed
(converted from existing monitoring wells) under Injection Permit WI4000091. The visual site
inspection found these wells were properly located and have been well maintained. No violation was
identified during the inspection.
The APS Winston-Salem Regional staff member also inspected the area where additional 16 injection
wells are proposed in the application for a major modification of the existing injection permit
WI0400091 to expand the injection system. The permit application is still under review. However, the
wells have been constructed before a permit has been issued. The wells were constructed by Ronald
Toothman, Trigon Exploration, Inc. Please note that:
(1) Constructing these injection wells without a permit is a VIOLATION of rule 15A NCAC 2C
.0211(a), and
(2) Failure to install these injection wells according to conditions as stated in the permit is a
VIOLATION of rule 15A NCAC 2C .0211(1)(1) and permit condition (Part I Item 3,
Construction of additional injection wells must be approved in advance by the Aquifer Protection
Section).
Pursuant to North Carolina General Statute (NCGS) 87-91(a), this office hereby notifies you that
Ronald Toothman, Certification # 2075 and Gilbarco, Inc are in violation of the Well Construction
Winston-Salem Regional Office
585 Waughtown Street Winston-Salem, NC 27107 One
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748 NorthCarolina
Internet: www.ncwaterquality.org �atura!!t�
An Equal Opportunity 1 Affirmative Action Employer
f

Standards indicated in Subchapter 2C, Title 15A, of the North Carolina Administrative Code. In
addition, Gilbarco, Inc. is in violation of the permit condition Part I Item 3 of Injection Permit
#WI0400091. Your prompt attention to the items described herein is required. You must stop all
injection activities immediately. Failure to comply with the State's rules, in the manner and time
specified, may result in the assessment of civil penalties and/or the use of other enforcement
mechanisms available to the State.
Should you have any questions, please call Shuying Wang or me at 336-771-5000.
Sincerely,
Sherri V. Knight, P.E.
Regional Supervisor, Aquifer Protection Section
cc: APS Central Files - permit # W10400091
WSRO File
Ronald Toothman, Trigon Exploration, Inc, 510 Industrial Ave., Greensboro, NC 27406
Christopher Hay, Kleinfelder Southeast, 313 Gallimore Dairy Rd., Greensboro, NC27409
Winston-Salem Regional Office
585 Waughtown Street Winston-Salem, NC 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Naturall