WI0400560_Permit (Issuance)_20201230

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individualpermit when constructed in accordance
with the rules of I5A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to infection
AQUIFER TEST WELLS 15A NCAC 02C .0220
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
INSITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS 15A NCAC 02C .0229 :
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: November 11, 2020 PERMIT NO. W10400560 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete sections B through F, K, N
(2) Aquifer Test Well.......................................Complete sections B through F, K, N
(3) Passive Injection System...............................Complete sections B through F, H-N
(4) X Small -Scale Injection Operation ......................Complete sections B through N
(5) Pilot Test.................................................Complete sections B through N
(6) Tracer Injection Well...... Complete sections B througlWGFWVD
B. STATUS OF WELL OWNER: Business/Organization C % I TO
a
C. WELL OWNER(S) —State name of Business/Agency, and Name and Title of person delegate
sign on behalf of the business or agency:
Name(s): Huffinan Oil Company, Jim Barnwell
Mailing Address: P.O. Box 730
City: Burlin on State: NC Zip Code:27216 County: Alamance
Day Tele No.: 336-227-8881 Cell No.: 336-227-8881
EMAIL Address: 'barnwell iftffinanoil.net
Fax No.: 336-226-7439
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 1

D.
E.
F.
G.
H.
PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Rose White Wrenn
Company Name
Mailing Address: 8320 Druids Lane
City: Raleigh State: NC_ Zip Code: 27613-4321 County: Wake
Day Tele No.: 919-848-0119 Cell No.:
EMAIL Address: rose.wrennAnc.rr.com Fax No.: -
PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Wayne Watterson
Company Name S&ME, Inc.
Mailing Address: 8646 West Market Street, Suite 105
City: Greensboro State: NC Zip Code: 27409 County: Guilford
Day Tele No.: 336-288-7180 Cell No.: 336-908-7653
EMAIL Address: wwatterson(a-.smeinc.com Fax No.:
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former White Brothers Facilit
North of Hurdle Mills Road and Hip-hway 157 intersection (Guess Road); PIN: 9981-00-68-0597.000
City: Hurdle Mills County: Person Zip Code: 27214
(2) Geographic Coordinates: Latitude": 0" or 36.273686 ON
Longitude": 0" or-79.046811 ° W
Reference Datum: - Accuracy:
Method of Collection: Google Earth
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
TREATMENT AREA
Land surface area of contaminant plume: Estimated 2,000 square feet
Land surface area of inj. well network: <10,000 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 50% (must be < 5% of plume for pilot test injections)
INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration of
injection over time.
A release of gasoline from a former underground storage tank system located on the property impacted
groundwater quality to levels greater than the 15A NCAC 2L .0202 groundwater quality standards. Multiple
monitor wells exist on the site. Two potable water supper wells are located within 200 feet of the release. The
use of Enviro-BAC using monitor wells MW-1 and MW-5 is planned to enhance degradation of petroleum
contaminant levels in the groundwater. One kilgram of Enviro-BAC concentrated powder, mixed with five
gallons of fresh water, provided by Progress Environmental, will be rg avity-fed into each individual monitor
well, MW-1 and MW-5, in approximate 1 gallon increments over a time interval of one hour, followed by 5 to
10 gallons of clean water.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant (attach additional sheets if necessary).
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at htM://deq.nc.gov/about/divisions/water-
resourc es/water-resources-permits/wastewater-branch/ground-water-protection/g round-water-approved-injectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
Injectant: Enviro-BAC
Volume of injectant: 5 gallons with sucrose additive added immediately prior to injection
Concentration at point of injection: 1 k 0.2 4/gallon)
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 2 Proposed 2 Existing (provide GW-Is)
(2) For Proposed wells or Existing wells not having GW-1 s, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Enviro-BAC solution will be placed into existing wells MW-1 and MW-5 within one month of receipt of the
notification permit number.
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The injection of Enviro-BAC solution is not expected to result in violations of the 2L Standards. Monitor well
MW-1 and MW-5 will be sampled for analysis of volatile organic compounds approximately 1 month following
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: `I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injectioy well and all rellaater�rrppurtenances in accordance with the 1 SA NCAC 02C 0200 Rules.
Watterson; Senior Engineer, Agent for Huffman Oil Co.)
of Applica Print or Type Full Name and Title
Propgty Owner if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C.0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the landowner, in the
absence of contrary agreement in writing.
See attached Site Access Agreement signed by Rose Wrenn dated November 29. 2019.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of his NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 4

Huffman Oil Company
P.O. Box 730
Burlington, NC 27216-0730
Dear Mr. lames A. Barnwell, Jr.:
RE: Site Access Agreement for Soil and Groundwater Assessment and
Remedial Actions at the Incident Known as White Brothers
Incident Number 15076, Hurdle Mills, Person County, NC
I am the owner of the property identified as Person County Parcel Identification
Number 9981-00-68-0597.000 and PIN 9981-00-68-1685.000 located on Hurdle
Mills Road in Hurdle Mills, North Carolina and hereby permit Huffman Oil
Company and its contractor, S&ME, Inc., to enter upon said property for the
purpose of conducting assessment and remedial activities associated with soil
and groundwater impacted from a former underground storage tank system
(incident 15076) at the property.
I am granting permission with the understanding that:
1. Prior to entering the property, Huffman Oil Company or its contractor will
notify the property owner of planned activities at the property.
2. Any assessment or remedial actions shall be conducted solely to address the
existing impacts to soil and groundwater from the former UST system at the
property. The purpose of assessment or remedial actions will be to reduce
petroleum concentrations in the soil and groundwater to concentrations
acceptable to the Underground Storage Tank (UST) Section of the North
Carolina Department of Environmental Quality Division of Waste
Management (NCDEQ), in order for the NCDEQ to issue a Notice of No
Further Action for the release incident.
3. The costs for assessment or remedial activities at the site shall be borne by
the Huffman Oil Company or its contractor. Huffman Oil Company or its
contractor shall protect and prevent damage to the surrounding lands.
4. Unless otherwise agreed, Huffman Oil Company or its contractor shall have
access to the site by the shortest feasible route to the nearest public road.
Huffman Oil Company or its contractor may enter upon the land at
reasonable times and have full right of access during the period of the work.

5. The information derived from any assessment or remedial activity shall be
made available to the owner upon request.
I agree not to interfere with, remove, or any way damage Huffman Oil
Company's well(s) or its contractor's well(s) or equipment during the
investigation.
Sincerely,
Signature
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SOURCE: HURDLE MILLS NC QUADRANGLE, 7.5-MINUTE SERIES US TOPO (2016).
A� VICINITY MAP
r' WHITE BROTHERS FACILITY
HURDLE MILLS, NORTH CAROLINA
0 2000 4000
GRAPHIC SCALE (IN FEET)
SCALE:
FIGURE NO.
AS SHOWN
1
DATE:
JULY, 2018
PROJECT NUMBER
43S8-18-030

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Well ID Project Name
MW-1 White Brothers
S&ME Staff Installation Date County
Project Number
4358-18-030
City
Well Permit Number
Person
Hurdle Mills
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Flush Monitor Well
Water Level at TOB (0.01 ft- BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
Hollow Stem Auger
Depth to Water (0.01 ft- bgs)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs)
Borehole Diameter (1 in)
17,9j
3/25/20 0:00
27.0
8.25-inch
TOC Relative to Ground 0.3 ft F
Depth Below Ground Surface (ft-basl
Top of Seal - 16.0 0.1 ft-bgs
Top of Filter Pack - 18.0 0.1 ft-bgs
Top of Screen - 20.0 0.1 ft-bgs
Screened Interval - 7.0 0.1 ft-bgs
Bottom of Screen - 27.0 0.i ft kags .: EE
Bottom of Filter Pack - 27.7 0.1 ft-bgs ::
Cave In - 0.0 0.1 ft-bgs
Total Boring Depth - 27.7 0.1 ft-bgs
Pad Type
Protective Casing
Casing Material
Casing Interval (0.1 ft-bgs)
0.3
to
20.0
Screen Type
Screen Interval (0.1 ft-bgs)
20.0
to
27.7
Grout Type
Grout Interval (0.1 ft-bgs)
0.3 TtoT
16.0
Seal Type
Seal Interval (0.1 ft-bgs)
16.0
to 18.0
Filter pack
Filter Pack Interval (0.1 R-bgs)
18.0
to
27.7
Development
Development Volume (gal)
Notes:
8TOC - Below Top of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date: 9/1/17 2:10 PM

•
Well ID Project Name
MW-5 White Brothers
S&ME Staff Installation Date County
Project Number
4358-18-030
City
Well Permit Number
Person
Hurdle Mills
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Flush Monitor Well
Water Level at TOB (0.01 ft- BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
Air Hammer
Depth to Water (0.01 ft- bgs)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs
Borehole Diameter (1 in)
15.06
3/25/20 0:00
46.7
6-inch
TOC Relative to Ground 0.3 ft
Depth Below Ground Surface [ft-bgsi
Top of Seal - 38.0 0.1 ft-bgs
Top of Filter Pack - 40.0 0.1 ft-bgs
Top of Screen - 42.0 0.1 ft-bgs
Screened Interval - 4.7 0.1 ft-bgs
Bottom of Screen - 46.7 0.1 ft-bgs
Bottom of Filter Pack - 47.0 0.1 ft-bgs
Cave In - 0.0 0.1 ft-bgs
Total Boring Depth - 470 0.1 ft-bgs
Pad Type
Protective Casing
Casing Material
Casing Interval (0.1 ft-bgs)
0.3
to
42.0
Screen Type
Screen Interval (0.1 ft-bgs)
42.0
to
47.0
Grout Type
Grout Interval (0.1 ft-bgs)
0.3 to
38.0
Seal Type
Seal Interval (0.1 ft-bgs)
38.0
to 40.0
Filter Pack
Filter Pack Interval (0.1 ft-bgs)
40.0
to 47.0
Development
Development Volume (gal)
Notes
BTOC - Below Tap of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date: 9/1/17 2:10 PM

s'
Water Resources
Environmental Quality
August 2, 2017
RE: EnviroBac
To Whom It May Concern:
ROY COOPER
Governor
MICHAEL S. REGAN
Secrelarr
S. JAY ZIMMERMAN
Director
The remediation compound EnviroBac (formerly ProgressBlend) made by Bio-Cat
Microbials is on the NC Division of Water Resources list of approved additives. If you have any
questions, please contact Michael Rogers at 919-807-6412 or [e-mail].
Best Regards,
ZQ�
Michael Rogers, P.G. (NC & FL)
Underground Injection Control (UIC) Manager - Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
cc: File
''Nothing Cornpares ---,
State ol'Nonh Carolina I Environmental Quality I Division ol" Water Resources
WatcrQuality Wgional OReralious Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

810-CAT
Microbials
� nnM_jM1T6nr6W=
Form: Powder SZE _
Section 1: Identification _
Product Identifier: EnviroBac
Other Identifier: NONE
Recommended Use: See Product Literature
Supplier Information: 689 Canterbury Rd
Shakopee, MN 55379
(p)952-445-4251 (f) 952-445-7233
info®bio-cat.comwww,bio-cat.com
Emer ency Phone: [phone] Sam - 4 m EST
Section 2: Hazard Identification
Hazard Classification:
Eye Damage/Irritation Category 2B
Skin Corrosion/Irritation Category 2
Signal Word: Warning
Hazard Statements:
H315 Causes skin irritation.
H320 Causes eye irritation.
i
Pictogram(s):
Precautionary Statement(s):
P264 Wash face and hands thoroughly after handling.
P280 Wear protective gloves/protective clothing/eye protection/face protection.
Response Statement(s):
P302/352 IF ON SKIN: Wash with plenty of water.
P305/351 /338 IF IN EYES: Rinse cautiously with water for several minutes. Remove contact
lenses, if present and easy to do. Continue rinsing. Immediately call a poison center/doctor.
P308/311 IF exposed or concerned: call a poison center/doctor,
P332/313 If irritation occurs: get medical advice/attention.
P337/313 If eye irritation persists: get medical advice/attention.
P362/364 Take off contaminated clothing and wash it before reuse.
Hazards Not Otherwise Categorized:
Moderate Respiratory Irritant
Section 3: Composition/ Information on Ingredients
Name: Proprietary bacterial blend CAS Number: N/A % by weight: 3.5-6%
Name: Maltodextrin CAS Number: 9050-36-3 %by weight: 2-3.5%
Name: Sodium chloride CAS Number: 7647-14-5 % by weight: Remainder %
Section 4: First -Aid Measures
Inhalation: If inhaled remove from contaminated area to fresh air. Report the situation. Seek
medical attention if allergic response is exhibited.
Page 1 of 3

Section 10: Stability and Reactivity
Reactivity:
Not available �
Chemical Stability:
Stable under normal storage conditions
Hazardous reactions:
Not available
Conditions to avoid:
Not available
Incompatible materials:
Not available
Hazardous Decomposition Products: Not available
Section 11: Toxicological Information
Routes of Exposure:
Eye contact, skin contact, ingestion, inhalation
Symptoms:
Immediate:
May cause irritation to the eyes, skin, mucus membranes, and the
upper respiratory tract
Delayed:
Not available
Acute toxicity:
Not available
Eye Irritation:
May cause minor irritation
Skin Irritation:
May cause minor irritation
Respiratory Irritation:
May cause minor irritation
Sensitization towards product: There is no evidence of sensitizing potential
Germ cell mutagenicity:
Not available
Reproductive toxicity:
Not expected to produce reproductive toxicity
Carcino enicit :
Not classified as a carcinogen by IARC, OSHA, or NTP
_
Section 12: Ecological Information
Ecotoxicity:
Not available
Persistence and degradability:
Product is readily biodegradable
Bioaccumulative potential:
Not available
Mobility in soil:
Not available
Other adverse effects:
Not available
Section 13: Disposal Considerations
No special disposal method required, except that in accordance to all applicable federal, state, and
local re ulations.
Section 14: Transport Information
Harmonized Tariff Code:
3002.90.10 (for Microbials)
UN Number:
Not classified
UN Proper Shipping Name:
Not classified
Transportation Hazard Class:
Not classified
Packing Group:
Not classified
Transport Environmental Hazard:
Not classified
Transport Special Precautions:
Not classified
MARPOL:
Not classified
Section 15: Regulatory Information
All components of this product are
listed or exempt from listing on the TSCA Invent
Section 16: Other Information
Revision History: Effective Date: 04/25/17 Supersedes: First Issue GHS 2015 FORMAT
The informotion contained in this Safety Data Sheet, as of the issue dote, is believed to be true and correct. However, the
accuracy or completeness of this information and any recommendations or suggestions ore made without warranty or
guarantee. Since the conditions of use are beyond the control of the company, it is the responsibility of the user to determine
the conditions of safe use of this product. The information does not represent analytical specifications. END OF SDS
Page 3of3

North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are `permitted by rule" and do not require an individualpermit when constructed in accordance
with the rules of 15A NCAC 02C.0200 (NOTE: This form must be received at least 14 DAYS prior to infection)
AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection Systems - In -well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small -Scale Injection Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests - Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: November 11, 2020 PERMIT NO. (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1) Air Injection Well......................................Complete
sections B through F, K, N
(2) Aquifer Test Well.......................................Complete
sections B through F, K, N
(3) Passive Injection System...............................Complete
sections B through F, H-N
(4) X Small -Scale Injection Operation ......................Complete
sections B through N
(5) Pilot Test.................................................Complete
sections B through N
(6) Tracer Injection Well...................................Complete
sections B through N
B. STATUS OF WELL OWNER: Business/Organization
C. WELL OWNER(S) — State name of Business/Agency,
and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Huffman Oil Company, Jim Barnwell
Mailing Address: P.O. Box 730
City: Burlington State: NC Zip Code:27216 County: Alamance
Day Tele No.
336-227-8881
Cell No.: 336-227-8881
EMAIL Address: lbamwellghuffmanoil.net Fax No.
336-226-7439
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 1

D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: Rose White Wrenn
Company Name
Mailing Address: 8320 Druids Lane
City: Raleigh State: _NC_ Zip Code: 27613-4321 County: Wake
Day Tele No.: 919-848-0119 Cell No.:
EMAIL Address: rose.wrenn(a,nc.rr.com Fax No.:
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Wayne Watterson
Company Name S&ME, Inc.
Mailing Address: 8646 West Market Street, Suite 105
City: Greensboro State: NC_ Zip Code: 27409 County: Guilford
Day Tele No.: 336-288-7180 Cell No.: 336-908-7653
EMAIL Address: wwatterson(&smeinc.com Fax No.:
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former White Brothers Facility
North of Hurdle Mills Road and Highway 157 intersection (Guess Road); PIN: 9981-00-68-0597.000
City: Hurdle Mills County: Person Zip Code: 27214
(2) Geographic Coordinates: Latitude": it or 36.273686 ON
Longitude*
Reference Datum:
Method of Collection: Google Earth
if or-79.046811 ° W
Accuracy:
"FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume: Estimated 3,000 square feet
Land surface area of inj. well network: <10,000 square feet (< 10,000 ftz for small-scale injections)
Percent of contaminant plume area to be treated: 50% (must be < 5% of plume for pilot test injections)
H. INJECTION ZONE MAPS — Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 2

I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES — Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration of
injection over time.
A release of ,gasoline from a former underground storage tank system located on the property impacted
groundwater quality to levels greater than the 15A NCAC 2L .0202 groundwater quality standards. Multiple
monitor wells exist on the site. Two potable water supply wells are located within 200 feet of the release. The
use of Enviro-BAC using monitor wells MW-1 and MW-5 is planned to enhance degradation of petroleum
contaminant levels in the groundwater. One kilogram of Enviro-BAC concentrated powder, mixed with five
gallons of fresh water, provided by Progress Environmental, will be ,gravity -fed into each individual monitor
well, MW-1 and MW-5, in approximate 1 gallon increments over a time interval of one hour, followed by 5 to
10 gallons of clean water.
J. APPROVED INJECTANTS — Provide a MSDS for each injectant (attach additional sheets if necessary).
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at hltp:Hdeg.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/eround-water-approved-injectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
807-6496).
Injectant:
Volume of injectant: 5 gallons with sucrose additive added immediately prior to injection
Concentration at point of injection: 1 kg(0.2 k /g_gallon)
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: 2 Proposed 2 Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-Is, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as -built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 3

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Enviro-BAC solution will be placed into existing wells MW-1 and MW-5 within one month of receipt of the
notification permit number.
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The injection of Enviro-BAC solution is not expected to result in violations of the 2L Standards. Monitor well
MW-1 and MW-5 will be sampled for analysis of volatile organic compounds approximately 1 month following
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/Applicant: "I hereby certify, under penalty of law, that I am familiar with the information
submitted in this document and all attachments thereto and that, based on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility offines and imprisonment,
for submitting false information. I agree to construct, operate, maintain, repair, and ifapplicable, abandon the
injectioq well and all relgteoppurtenances in accordance with the 15A NCAC 02C 0200 Rules. "
of Applicai`t' Print or Type Full Name and Title
Property Owner (if the property is not owned by the Well Owner/Applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
(15A NCAC 02C .0200). "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A well
is real property and its construction on land shall be deemed to vest ownership in the landowner, in the
absence of contrary agreement in writing.
See attached Site Access Agreement signed by Rose Wrenn dated November 29, 2019.
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a .signature on this form.
Please send 1 (one) hard color copy of his NOI along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR— UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Pennitted G W Remediation NOI Rev. 3-21-2018 Page 4

Huffman Oil Company
P.O. Box 730
Burlington, NC 27216-0730
Dear Mr. James A. Barnwell, Jr.:
RE: Site Access Agreement for Soil and Groundwater Assessment and
Remedial Actions at the Incident Known as White Brothers
Incident Number 15076, Hurdle Mills, Person County, NC
I am the owner of the property identified as Person County Parcel Identification
Number 9981-00-68-0597.000 and PIN 9981-00-68-1685.000 located on Hurdle
Mills Road in Hurdle Mills, North Carolina and hereby permit Huffman Oil
Company and its contractor, S&ME, Inc., to enter upon said property for the
purpose of conducting assessment and remedial activities associated with soil
and groundwater impacted from a former underground storage tank system
(incident 15076) at the property.
I am granting permission with the understanding that:
1. Prior to entering the property, Huffman Oil Company or its contractor will
notify the property owner of planned activities at the property.
2. Any assessment or remedial actions shall be conducted solely to address the
existing impacts to soil and groundwater from the former UST system at the
property. The purpose of assessment or remedial actions will be to reduce
petroleum concentrations in the soil and groundwater to concentrations
acceptable to the Underground Storage Tank (UST) Section of the North
Carolina Department of Environmental Quality Division of Waste
Management (NCDEQ), in order for the NCDEQ to issue a Notice of No
Further Action for the release incident.
3. The costs for assessment or remedial activities at the site shall be borne by
the Huffman Oil Company or its contractor. Huffman Oil Company or its
contractor shall protect and prevent damage to the surrounding lands.
Unless otherwise agreed, Huffman Oil Company or its contractor shall have
access to the site by the shortest feasible route to the nearest public road.
Huffman Oil Company or its contractor may enter upon the land at
reasonable times and have full right of access during the period of the work.

5. The information derived from any assessment or remedial activity shall be
made available to the owner upon request.
I agree not to interfere with, remove, or any way damage Huffman Oil
Company's well(s) or its contractor's well(s) or equipment during the
investigation.
Sincerely,
&", wi W�ltti
Signature
G5 e WA i l e W t•e Viva
Type/Print Name
?, 3 a c Z),-uids Lane,
Address
�alei.yh , N C
City/State/Zip Code
q19-�11�1-oliq
Phone Number
27k 1 3-y 3z.J
a 912019
Date

11 09 2020 03:33 OWNERSHIP 2204303
PROPERTY DESCRIPTION
TAX DESCRIPTION
MAP NUMBER
CARD#
WRENN ROSE WHITE
WRENN JOHN RANDOLPH
8320 DRUIDS LN
RALEIGH, NC 27613-4321
DEED: 999 715 1 30 2019 $20,000
LOT & STORE
PLATBOOK/PAGE/DATE: 17 174 03/08/2017
NB: 00000 00000
HURDLE MILLS RD ROXBORO
BUSHY FORK
A31 91
RECORD NUMBER: 7398
ROUTE: BF 113 068
LISTER: PLC 5/15/2018
REVIEWER: PLC 6 4 2018
1 / 1
TOPO
STREET
UTILITIES
NOTES
AC
ROLLING
PAVED
WELL
SEPTIC
ELECTRIC
NCIV F18
MISC IMP IS WHITE BROS STORE
0.8800
#
LAND CLASS
SIZE
BASERATE
*
AU
* AD3
-
AD3 RATE
* UNITS
=
LNDVALUE
1
12ABLDGSIT2
0.88
1600
1.0
1.0
1728
0.88
1520
ACREAGE FACTOR: 6 FRONTAGE FACTOR: LAND VALUE
1520
#
OTHER FEATURES
SIZE
BASERATE
COND
AD3 RATE
UNITS
VALUE
1
14 SHOP
46 * 58
0.00
0.00
0.00
2668
2
26 MISCBLDG
1 * 1
0.00
0.00
0.00
1
OTHER FEATURES VALUE:
FOUNDATION
XTR_FINISH
ROOF TYPE
ROOF MTRL
SIZE/QTY
STHT
BDRM
WALL FINSIH
FLOORS
HEAT&AIR
HEAT FUEL
BLDING #
IMPROVEMENT TYPE:
GRADE: AYB: EYB: CONDITION: DEPR TABLE: S FT TABLE:
DIMENSIONS:
STRUCTURE
SKETCH -SF
* STHT
=
AREA I
RATE
* GRDE
+ HEAT
+ EXWL
* WLHT
= AD7RATE
* AREA
=
RPCN
* DEPF
* CNDF
I =
R-VALU
HSF TSF RPCN-/HSF VALU-/HSF
STRUCTURE VALUE
CARD VALUE 1520
VALUATION THIS CARD + OTHER CARD = VALUE PREV-VAL P-N% OTHER CARDS VALUE
LAND 15206 15206 8800 0.58 TOTAL VALUE 1520
OTHER FEAT 0 0 0 0.00
STRUCTURE 0 0 0 0.00
TOTAL 15206 15206 9900 1.54 NBHD ADJUSTMENT: 1.000
(758265) Group:0 TAX YEAR: 2020 APPRAISED VALUE 1520
Person County, NC REVAL YEAR: 2013 DEFERRED VALUE 0 TAXABLE VALUE 152061

r
-
i
pRNEZ�,y
so
I
Q
157 D
J
U'NIOy'GROYE•EyUREy yj
650
SITE
SATT
FIELD RD
rao
00
b�
` 6so
��
r,
Hur-CM3 r;
itfield/ti 12—
�}
,��sa
��RO�
^�� 1°I1•��
tu'0
TERRYRD
2 D
-DAISY LN
157
v
m
f
CH RLIEM�ONK�-RDA
0 2000 4000
SOURCE: HURDLE MILLS NC QUADRANGLE, 7.5-MINUTE SERIES US TOPO (2016). GRAPHIC SCALE (IN FEET)
VICINITY MAP
SCALE:
FIGURE NO.
AS SHOWN
DATE:
JULY, 2018
PROJECT NUMBER
III
WHITE BROTHERS FACILITY
HURDLE MILLS, NORTH CAROLINA
4358-18-030

ME
U
100
90
80
70
60
50
40
30
20
10
100
90
80 —
70 —
60
50
40
30
20
10
N
I
B—B'
I c I
0
W
U
w
Ln--.)
IU
:,,: ry
5ia-
NC HWY 157
CLAYEY
SILT FILL
= SILT TO SLIGHTLY SANDY SILT
(BQL) - 14)—
_ BT = SANDY SILT — — SILT -
AR — — (BQL)
UNFRACTURED
MAFIC
ROCK I
LIGHTLY FRACTURED
I`Bk C ROCK \
UNFRACTURED
MAFIC ROCK
— FELSIC ROCK
HIGHLY FRACTURED
INTERMEDIATE ROCK
m
0
w
U
W
U-) --D Q0
a -
CLAYEY
T
I -
F-
56
(466
BT
f(466) 06 5.6 BQL
BT
(2) — — MAFIC ROCK
BT
I
NC HWY 157
SILT TO SLIGHTLY SANDY SILT
= (BQL)
SA T
_BT
\ —
_
UNFRACTURED
I
MAFIC
5.6
BQL
ROCK
FRACTURED
/SLIGHTLY
FELSIC ROCK
UNFRACTURED
MAFIC ROCK
FELSIC ROCK
-_ -_ MAFIC
ROCK
HIGHLY FRACTURED
INTERMEDIATE ROCK
175
GE
30 15
HORI2
VER

August 2, 2017
RE: EnviroBac
To Whom It May Concern:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary•
S. JAY ZEAMERMAN
Director
The remediation compound EnviroBac (formerly ProgressBlend) made by Bio-Cat
Microbials is on the NC Division of Water Resources list of approved additives. If you have any
questions, please contact Michael Rogers at 919-807-6412 or [e-mail].
Best Regards,
Michael Rogers, P.G. (NC & FL)
Underground hljection Control (UIC) Manager - Hydrogeologist
Division of Water Resources
Water Quality Regional Operations Section
cc: File
--Nothing Corril-,)ares :-
State of North Carolina I Environmental Quality l Division of Water Resources
\-Nato Quality RL-ional operations Seclioo
1636 Mail Service. Center ( Raleigh, North Carolina 27699-1636
919-707 9129
rr.:..s::m;a;:c�.ire:u.._-•�-:^-a,.�..-»^:�-c.V.•u., :,; wW.s—.....••;cc:.�'•-....- •...^�.,....• �,..'y'^.

Form: Powder (SZE)
Section 1: Identification
Product Identifier: EnvhoBuc
Other Identifier: NONE
Recommended Use: See Product Literature
Supplier Information: 689Canterbury Rd
Shakopee, k4N553y9
(p)952-445-4251 (f)962-446-7233
| Sectkon2: Hazard Identification |
Hazard Classification:
Eye Damage/irritation Category 2B
Skin Corrosion/Irritation Category 2
Signal Word: Warning
Hazard Statements:
H316 Causes skin irritation.
H320 Causes eye irritation.
PkctoQvonn(s): `VI
PrecouhonoryStotement(s:
P264 Wash face and hands thoroughly after handling.
P280 Wear protective gloves/protective clothing/eye protection/face protection.
RexpunseStcdemnert(s):
P302/352 |F0NSKIN: Wash with plenty ofwater.
P305/351/338 |F|NEYES: Rinse cautiously with wafer for several minutes. Remove contact
lenses, ifpresent and easy todo. Continue rinsing. Immediately call o poison center/doctor.
P308/311 |Fexposed orconcerned: call opoison cenfer/dnc1or.
P332/313 |firritation occurs: get medical advice/oltenfion.
P337/313 |feye irritation persists: get medical odvice/oMenhon.
P362/364 Take off contaminated clothing and wash i|before reuse.
Hazards Not Otherwise Categorized:
Moderate Respiratory Irritant
Section 3: Composition/ Information on Ingredients
Name: Proprietary bacterial blend CAS Number: N/A %byweight: 3.5-6%
Name: K8a|todex hn CAS Number: 3050'36-3 %byweight: 2-3.5%
Name: Sodium ch|ohde CAS Number: 7047'14'5 %by weight: Remaindor%
Section 4: First -Aid Measures
Inhalation: |finhaled remove from contaminated area tofresh air. Report the situation. Seek
Page I of 3

Section 10: Stability and Reactivity
Reactivity: Not available
Chemical Stability: Stable under normal storage conditions
Hazardous reactions: Not available
Conditions to avoid: Not available
Incompatible materials: Not available
Hazardous Decomposition Products: Not available
Section 11: Toxicological Information
Routes of Exposure: Eye contact, skin contact, ingestion, inhalation
Symptoms:
Immediate: May cause irritation to the eyes, skin, mucus membranes and the
upper respiratory tract
Delayed:
Not available
Acute toxicity:
Not available
Eye Irritation:
May cause minor irritation
Skin Irritation:
May cause minor irritation
Respiratory Irritation:
May cause minor irritation
Sensitization towards product:
There is no evidence of sensitizing potential
Germ cell mutagenicity:
Not available
Reproductive toxicity:
Not expected to produce reproductive toxicity
Carcinogenicity:
Not classified as a carcinogen by IARC, OSHA, or NTP
Section 12: Ecological Information
Ecotoxicity:
Not available
Persistence and degradability:
Product is readily biodegradable
Bioaccumulative potential:
Not available
Mobility in soil:
Not available
Other adverse effects:
Not available
Section 13: Disposal Considerations
No special disposal method required, except that in accordance to all applicable federal, state, and
local regulations.
Section 14: Transport Information
Harmonized Tariff Code:
3002.90.10 (for Microbials)
UNNumber:
Not classified
UN Proper Shipping Name:
Not classified
Transportation Hazard Class:
Not classified
Packing Group:
Not classified
Transport Environmental Hazard:
Not classified
Transport Special Precautions:
Not classified
MARPOL:
Not classified
Section 15: Regulatory Information
All components of this product are listed or exempt from listina on the TSCA Inventorv.
Section 16: Other Information
Revision History: Effective Date: 04/25/17 Supersedes: First Issue GHS 2015 FORMAT
The information contained in this Safety Data Sheet, as of the issue date, is believed to be true and correct. However, the
accuracy or completeness of this information and any recommendations or suggestions are made without warranty or
guarantee. Since the conditions of use are beyond the control of the company, it is the responsibility of the user to determine
the conditions of safe use of this product. The information does not represent analytical specifications. END OF SDS
Page 3 of 3

Well ID
WELL
CONSTRUCTION
Project Name
1
Project Number
4358-18-030 A
s
I I
MW-1 White Brothers
S&ME Staff
Installation Date
County
City
Well Permit Number
Person
Hurdle Mills
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Flush Monitor Well
Water Level at TOB (0.01 ft-
BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
Hollow Stem Auger
Depth to Water (0.01 ft-
bgs)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs)
Borehole Diameter (1 in)
17.93
1 3/25/20 0:00
1
27.0
11 8.25-inch
TOC Relative to Ground
0.3
ft
Pad Type
Protective Casing
Casing Material
Depth Below Ground Surface (ft-bgs
Top of Seal - 16.0 0.1 ft-bgs
Casing Interval (0.1 ft-bgs)
0.3
to
20.0
Screen Type
Screen Interval (0.1 ft-bgs)
20.0
to
27.7
Grout Type
Top of Filter Pack - 18.0 0.1 ft-bgs
Grout Interval (0.1 ft-bgs)
Top of Screen - 20.0 0.1 ft-bgs
0.3
to
16.0
Seal Type
Screened Interval - 7.0 0.1 ft-bgs
Bottom of Screen - 27.0 0.1 ft-bgs
Seal Interval (0.1 ft-bgs)
16.0
to
18.0
Filter Pack
Filter Pack Interval (0.1 ft-bgs)
18.0
to
27.7
Development
Bottom of Filter Pack -
Cave In -
Total Boring Depth -
27.7
0.0
27.7
0.1 ft-bgs
0.1 ft-bgs
0.1 ft-bgs
Development Volume (gal)
Notes:
BTOC - Below Top of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date: 9/1/17 2:10 PM

Well ID
Project Name
I
Project Number
4358-18-030
City
=a
E
Well Permit Number
MW-5 White Brothers
S&ME Staff Installation Date
County
Person
Hurdle Mills
NA
Drilling Contractor
License Number
Drill Rig
Well Type / Use
Flush Monitor Well
Water Level at TOB (0.01 ft-
BTOC)
Date/Time
Northing (0.1 ft)
Land Surface Elev. (0.01 ft)
Drilling Method
Air Hammer
Depth to Water (0.01 ft-
bgs)
Date/Time
Easting (0.1 ft)
Total Well Depth (0.1 ft-bgs)
Borehole Diameter (1 in)
15.06
3/25/20 0:00
46.7
6-inch
TOC Relative to Ground 0.3 ft F
Depth Below Ground Surface (ft-bgs
Top of Seal - 38.0 0.1 ft-bgs
Top of Filter Pack - 40.0 0.1 ft-bgs
Top of Screen - 42.0 0.1 ft-bgs
Screened Interval - 4.7 0.1 ft-bgs
Bottom of Screen - 46.7 0.1 ft-bgs
Bottom of Filter Pack - 47.0 0.1 ft-bgs
Cave In - 0.0 0.1 ft-bgs
Total Boring Depth - 47.0 0.1 ft-bgs
Pad Type
Protective Casing
Casing Material
Casing Interval (0.1 ft-bgs)
0.3
to
42.0
Screen Type
Screen Interval (0.1 ft-bgs)
42.0
to
47.0
Grout Type
Grout Interval (0.1 ft-bgs)
0.3
to
38.0
Seal Type
Seal Interval (0.1 ft-bgs)
38.0
1 to
1 40.0
Filter Pack
Filter Pack Interval (0.1 ft-bgs)
40.0
to
47.0
Development
Development Volume (gal)
Notes:
BTOC - Below Top of Casing
TBD - To Be Determined
For lithologic information
see attached boring log
Form Revision Date: 9/1/17 2:10 PM