WI0300440_DEEMED FILES_20210219

Permit Number WI0300440
Program Category
Deemed Ground Water
Permit Type
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Former Pepsi Bottling Facility
Location Address
1462 W Airline Ave
Gastonia
Owner
Owner Name
Bottling Group LLC
Dates/Events
NC 28052
Scheduled
Orig Issue
8/12/2020
App Received Draft Initiated Issuance
7/31/2020
Reg ulated Activities
Groundwater remediation
Outfall
Central Files: APS SWP
Permit Tracking Slip
Status
Active
Project Type
New Project
2/19/2021
Version
1.00
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Mooresville
County
Gaston
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
David Patrick
1111 Westchester Ave
White Plains NY 10604
Public Notice Issue
8/12/2020
Re q uested /Received Events
Effective
8/12/2020
Expiration
Waterbody Name Streamlndex Number Current Class Subbasin
NC Department of Environmental Quality-Division of Water Resources (DWR)
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C .0200 (NOTE: This form must be received at least 14 DAYS prior to in jection)
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 S ystems -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 O perations -Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells is located within an area that does not exceed five percent of the land surface
above the known extent of groundwater contamination. An individual permit shall be required to conduct more
than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
5) In-Situ Thermal Wells (IST)-Used to 'heat' contaminated groundwater to enhance remediation
Print Clearly or Type Information. Illegible Submittals Will Be Returned as Incomplete.
DATE: July24 ,20__1Q__ PERMIT NO. ________ (to be filled in by DWR)
NOTE-If this NOI is being submitted as notification ofa modification ofa previously issued NOI for this site (e.g.,
different injection wells, plume, additives, etc.) and still meets the deemed permitted by rule criteria, provide the
previously assigned permit tracking number and any needed relevant information to assess and approve injection:
Permit No. WI~------------Issued Date: _________ _
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
B.
(1)
(2)
(3)
(4)
(5)
(6)
--~Air Injection Well ....................................... Complete sections B through F, J, M
___ Aquifer Test Well ....................................... Complete sections B through F, J, M
___ Passive Injection System ............................... Complete sections B through F, H-M
___ Small-Scale Injection Operation ...................... Complete sections B through M
X Pilot Test. ................................................ Complete sections B through M
___ In-Situ Thermal (1ST) Well ........................... Complete all sections except K
STATUS OF WELL OWNER: Business/Organization
Deemed Permitted GW Remediation NOI Rev. 2-14-2020
RECEIVED
JUL 31 2020
NCDEQ/DWR
Central Office Page 1
C. WELL OWNER(S) -State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): Bottling Group, LLC, C/O David Patrick, Le gal Senior Director
Mailing Address: __ __,1'--"1--"'l -=--l _,W--'---=es=t =ch=e=s=te=r -=--A=vc..-=e'--_________________ _
City: White Plains State: _NY_ Zip Code: 10604 County: Westchester
Day Tele No.: 914-767-7107 Cell No.: 914-260-3605
EMAIL Address: David.Patrick(a).p e psico .com Fax No.: ___________ _
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: --~Mr='-'· N'--'=il=es"-M=i=ll=er"'--"-P=as=t=ora,.._ ____________________ _
Company Name ___ N=-=e-'--'w_,H=ol=..y_,T"-'e=m=p=l=e _,C=h=ur=-c=h~--------------------
Mailing Address: __ ---=P_,O'--=B=ox=-=-9-'-76"-----------------------
City: Gastonia State: _NC_ Zip Code: 28053 County: Gaston
Day Tele No.: 704-853-0670 Cell No.: 704-923-3032
EMAIL Address: Fax No.: __________ _
E. PROJECT CONTACT (Typically Environmental Consulting/Engineering Firm)
F.
Name and Title: --~E=r=in=-=G=r=ee=n=e'-'-. -=-P""ro""'j-=--ec=t-=--M=an=a=g=era,.._ _______________ _
Company Name ---""A"-'T'""'C"-"-'A=s=so=c=ia=t=es"-o=f=N~ort=h=-=C=ar=o=l=in=a'-'-. -=-P~.C=·----------------
Mailing Address: ------'7-=6-=--0-=--6 _,Wh-'-=1=·te=h=a=ll=E=x=e=c=ut=iv-'-e~C-=--en=t=e"-r =D-=--n=·v~e~. -=-Su=i=tea...-=--80"-0a,.._ ___________ _
City: Charlotte State: _NC_ Zip Code: 28273 County: Mecklenburg
Day Tele No.: 704-529-3200 Cell No.: 704-817-0896
EMAIL Address: erin.greenet@,atc.e s.com Fax No.: ----'7~0_4-~5=29~-=32=7~2~---
PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: Former Pepsi Bottling Facility
1462 West Airline Ave
City: ___ G~as~t -'-on=i=a _________ County: Gaston Zip Code: 28052
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or ~35-._26~3_,0~8_3°_N _____ _
Longitude**: 0 "or 81.208098° W
Reference Datum:. __ ---=N---'-'A'--"--' ____ Accuracy: NA
Method of Collection:._G=o=o 0'="l=e-"'E=arth=-=.___ ___________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COORDINATES.
G. TREATMENT AREA
Land surface area of contaminant plume:.~2=.4-'-0=0'--___ square feet
Land surface area ofinj. well network: _______ square feet 0=; 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 5% (must be~ 5% of plume for pilot test injections)
Deemed Pennitted GW Remediation NOi Rev. 2-14-2020 Page 2
H. INJECTION ZONE MAPS -Attach the following to the notification.
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES AT THE SITE -Provide a brief narrative
regarding the cause of the contamination, and purpose, scope, goals of the proposed injection activity:
ATC will a pp ly Enviro-BAC (a pro prietar bacterial blend) in monitorin,e wells MW-IR and MW-7R to promote
accelerated petroleum com pound biode gradation and reduce com pound concentrations to below the North
Carolina Groundwater Quali ty Gross Contamination Levels (GCLs ). For each well. one kilo g ram of Enviro-
BAC will be pre pared in a concentrated powder form . mixed with a provided sucrose additive and a pproximatel y
5 e:allons of fresh water. then gravi tv -fed into the well. An additional five to ten e allons of fresh water will be
a pp lied into each well to promote dis persion of the solution into the aquifer. This solution will deliver a unique
blend of non-patho genic , non-e:enetically modified microbial organisms to facilitate the bioremediation in
e:roundwater.
J. WELL CONSTRUCTION DATA
(1) No. of injection wells: _______ Proposed"_---=2'---__ Existing (provide NC Well
Construction Record (GW-1) for each well)
(2) Appx. injection depths (BLS): __ -'"-3-'--0-~4-'--5~ft'-------------------
(3) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
( c) Well contractor name and certification number
K. INJECTION SUMMARY
NOTE: On ly in jectants a1mroved b r the e pidemiology section o [the NC Division o[Public Health, Denartment
o f Health and Human Services can be in iected. A pnroved in iectants can be [o und online at
http://deq.nc.e.ov/about/divisions/water-resources/water-resources-permits/wastewater-branch/ground-water-
protection/e:round-water-approved-injectants . All other substances must be reviewed b r the DHHS prior to use.
Contact the UIC Pro gram [o r more in [o i f 1·ou wish to get a pp roval (o r a di ffe rent additive. However. please
note it ma r take 3 months or lon ger.
Injectant:EnviroBAC mixture and sucrose Total Amt. to be injected (gal)/event_: __ 2_K~g ______ _
Injectant_: ___________ Total Amt. to be injected (gal)/event_,_: __________ _
Injectant,_: ___ _ _ __ Total Amt. to be injected (gal)/event:
Deemed Permitted GW Remediation NOi Rev. 2-14-2020 Page 3
Amt. Water to be injected (gal/event): 30 gal
Total Amt. to be injected (gal/event): 30 gal
No. of separate injection events:.UNK Est. Total Amt. to be injected (gal): UNK
Source of Water(if applicable); .Municipal water from Mecklenburg County
L. MONITORING PLAN —.Describe below or in separate attachment a monitoring plan to be used to determine
if ► iolations of groundwater quality standards specified in St chapter OZL result from the injection activity.
Approximately 30 days tiger )lie inject ion event; ATC will perform a limited groundwater sampling event of
monitodnt~:weiis l -1R, MW-5. MW-71:c.and MW-I4R and analyze for volatile organic compounds by EPA
Method 620014: ATC Will also mcast}rn and record the field parameters.
SIGNATURE OF APPLICANT AND ,PROPERTY OWNER
Well Owner/App]icantt "1 hereby certify, under perialty of law; that 1 amfamiliar with the information
submitted- in: this- doC mien and all attachments thereto and that, based on my iiroiry of those individuals
Immediately responsible fir obtaining said information, I believe that the mfor►nation is true, accurate and
coinplete. I inn aware.tfrat there are significant penalties, including the possrblltty.af fines and imprisonment,
for submitting false ri fvrtnat;on. I agree to construct,operate, maintain, repair: mrd_rf'appiicabie. abandon the
inaction well and ed'appurIenances rn accordance with Me .IS 4 NCAC 02C 0200 Rules.'.
David H. Patrick. (✓egal.Senior Director, Operations
5[gnxture'of Appliestint Print or Type Full N me arfd TUN
Property Owner Of the Propertr.is not owned by the Weil OwneriApplicant):
",f.s owner of the property. an whtch.the irrjectton.wcll(s) are #v be -constructed and operated, Ihereby conse# t:tn
allow the applicant to construct each 1nJection.well'as outlinedin this application and agr•ec.that It shall .be the
responslblli9 oj'the applicant to ensure that the injection well(i) cot forin to the Well Construction Standards
(75, NCAC O2C. . O2iiOl. "
"Owner".means any person who holds the fee or other property rights in the well being constructed. A well
is real.;property and ifs constrtictioxl on land shall be deemed to vest ownership in the land owner, in the
atiscl}pd. of —contrary agreement. in writin /G J7 r 7
tgnaturc" of Property:Own r {s� if di arctic from appliennt] Print or Typo Full iVnrne flnel'Me
*fin access agreement between te.appl;cant orrd,propertyy owner may be submitted. in lieu of a signature= an this form.
Please send itoneyknO color copy ofrthis NOT 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 Servke Center
Raleigh, NC 27699-4636
Telephone: [phone]
De:erutd Permitted OW Remedlat{an NOI Rev. 2-14-2020
Page A

I Well Type I Date
Installed
Permanent 9/21/01
NOTES:
BGS -Below Ground Surface
ft -feet
As Built Construction Information -Monitoring Well MW-1 R
(Former) Pepsi Bottling Facility
Gastonia, North Carolina
NCDEQ Incident No. 8105
Depth of Sand Pack Bentonite Cement Grout Screened Casing (ft Interval (ft Interval (ft Interval (ft Interval (ft) BGS) BGS) BGS) BGS)
26 24-26 22-24 0 -22 26 -46
Well
Diameter
(inches)
2
NONRESIDENTIAL WELL cnrrsrRueno v RECORD
North Carolina bepa m i of Fnvin: mem and NaturalResources- tivisian of Water Quality
WELL CONTRACTOR CERTIFICATION H 4155
1. WELL CONTRACTOR:
Dsrld Brown
Well Contractor (Incl:Mdual) Name
Envlrorursental Ordlittg & Probing Serva:es, LLC (FOPS)
Web Canlradnr Company Nam
STREET ADDRESS 17538 Greenhill Road
Charlotte
NC 28278
City or Tom Stake Zip Code
( 704 , 607 7520
Arca code- Phone number
Z WELL INFORMATION:
SITE WELL ID Skii makable)
STATE WELL PERMIT#(rt eppt+[atiey
OWQ or OTHER PERMIT Alf applicable)
WELL USE (Ghedt A cahte HcE) MoNdtaring ir7 MurdctpatlPuh4c ❑
trueisetEur.crrrmercial ❑ Agricultural A Recauery0 Injection ❑
irrigations Other 0 {Font use)
DATE DRILLED 8f211i3
MW.7R
TIME COMPLETED AMO PMD
3. WELL LOCATION:
CITY: Gastonia COUNTY Gaston
1482 West Moe DAve, Gastonia, NC
Mamei I rir. Niinhors. Comneru nity. Subdivision, Lot No., Parcel, Zip Code)
TOPOGRAPHIC) LAND SETTING:
I:3Stape ©Valtey ['Flat EjRidge 0 Other
(shock appropriate box)
LATITUDE
LONGITUDE
May bo in dcgr e
finnetekreomata
inn decimal fixurat
Lahtuelellongitusde source: aGPS DTopographic msp
Wean or WO mast be shown on a USGS tape reap and
attached tothis farm synal usksg GPS)
4. FACTI TY-ii mamma or the 4u.Y+.so wroro9+e ova w'weed.
FACILITY ID #(it appbcablej
NAME OF FACILITY Fanner Pepsi Gastonia
sTREET ADDRESS 1462 Weer Aldine Drive
Gastonia MC
City cr Town Stye Zip Cade
CONTACT PERSON
MAILING ADDRESS
City or Twin Stake Zip Code
Area code- Phcne number
er
S WEl . DETAILS:
s TOTAL DEPTH: 45 It
la DOES WELL REPLACE E7QSTING WELL? VF..S pa NO Cl
e. WATER LEVEL Below Top c( Casing FT.
(Use •+• Fr Above Top of Casing)
d. TOP OF CASING IS FT. Above Land Surface'
'Top c[ casing tmninated atlor balm/land surface mayre:pare
•a variance in accorda ce ►sth 15A NCAC 2C .0116.
a. YIELD (gpm): METHOD OF TEST
t DISINFECTION: Type Amount
g. WATER TONES {depth}
From To From To_
Firrr_To Frrotn To
From To _ From To
8. CASING:
Thidan s/
Deppat t er Ws iv al
FTC% 20
From To Fk
From To Ft
7. GROUT: Depth Ma1uial Method
From 18 To 16 FL Be 4orete Tremie
Frc n To 0 Ft °rout
From To Ft
III. SCREEN: Dealt Moneta! Slot Sire Material
From 45 To 20 Ft 2 In, 0.01 in, PVC
From To FL In. tn.
From To Ft in. kt
6. SAND/GRAVEL PACK:
Depth Size Material
Front, 45 To 18 Ft. #2.med Sand
From To Ft,
Fran To Ft
10. DRILLING LOG
From To Formation Description
11. RE HARMS:
1 DO HEREBY CERTIFY THRYTHIS Mu_ WAS cgNSTRUCrE6piiADoZaDANCE t4Y114
aft W AC 7C, ►441.L AHD iFiAT A GAY of 7F18
RECORD HAS eF6nv OWNER.
SIGNATURE OF CERTIFIED WELL CONTRACTOR
fiolvid- tre,nano
8$10J13
DATE
PRINTED NAME OF PERSON CONSTRUCTING Ti-E WEU.
Submit the original to the Division of Water Quality within 30 days_ Attn: Information mot,
1617 Mail Service Center— Raleigh, NC 27699-7617 Phone No. [phone] ext 568.
Form GW-1 b
Rev. 7105

Safety Data Sheet
Form: Powder (SIE)
Section 1: Identification
Product Identifier:
Other Identifier:
Recommended Use:
Supplier Information:
Emergency Phone:
EnviroBac
NONE
See Product Literature
689 Canterbury Rd
Shakopee, MN 55379
(p)952-445-4251 (f) 952-445-7233
inf4abi0- ca l .cQmwww.bio-cc r.ccm
434-589-4777 8am - 4pm EST
Section 2: Hazard Identification
Hazard Classification:
Eye Damage/Irritation Category 2B
Skin Corrosion/Imitation Category 2
Signal Word: Warning
Hazard Statements:
H315
H320
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):
P3021352 IF ON SKIN: Wash with plenty of water.
P305/351/338 IF IN EVES: Rinse cautiously with water for several minutes. Remove contact
[erases, 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.
P3321313 If irritation occurs: get medical odvice/attention.
P337/313 If eye irritation persists: get medical advice/attention.
P3621364 Take off contaminated clothing and wash it before reuse.
Hazards Nat Otherwise Categorized:
Moderate Respiratory; Irritant
Causes skin irritation.
Causes eye irritation.
Section 3: Composition/ Information on Ingredients
Name: Proprietary bacterial blend CAS Number:. WA %by weight: 3.5-6%
Name: Maltodextrin CAS Number: 9050-36-3 % by weight: 2-3.5%
Name: Sodium chloride CAS Number: 7647-14-5 %by weight: Remainder °%
Section 4: First -Aid Measures
Inhalation: If inhaled remove from contaminated area to fresh air. Report the situation. Seek
medical attention if allergic response is exhibited.
Page 1 of 3

Eye Contact:
Skin Contact:
Ingestion:
In case of contact with eyes, flush eyes with low pressure water for at least 15 minutes.
If irritation develops, seek medical attention.
In case of contact with skin, wash skin with soap and cold water. Remove
contaminated clothing and wash.
if swallowed, rinse mouth and throat thorouahl; with tap water. Drink water.
Section 5: Fire -Fighting Measures
Suitable Extinguishing Media: Standard procedure for chemical fires. Foam. Wafer.
Non -Suitable Extinguishing Media: None
Specific Exposure Hazards:
Protective Equipment:
None
No species[ requirements
Section 6: Accidental Release Measures
Personal precautions,
Emergency Procedures:
Containment methods:
Cleanup Procedures;
Use only with adequate ventilation/personal protection. Avoid breathing
dust or spray mist. Avoid formation of dust and aerosols. (See section 8).
Prevent further leakage or spillage if safe to do so.
Contain and remove spilled product by mechanical means or with a
vacuum cleaner equipped with a high efficiency filter. Avoid formation
of aerosol.
Section 7: Handling and Storage
Safe Handling: Never handle powder without appropriate personal protective
equipment in accordance with Section 8. Avoid formation of dust.
Avoid splashing and high pressure washing. Ensure good ventilation of
the room when handling this product.
Storage: Keeo container thhtlyclosed in a cool, dry, well ventilated place.
Section 8: Exposure Controls/Personal Protection
Appropriate engineering controls: Adequate ventilation required for dusty conditions
Eye/face protection:
Skin protection:
Relpiratory Protection:
Wear protective glasses or eye shield
Impermeable gloves recommended
Use NIOSH approved respiratory protection such as full face mask
Section 9: Physical and Chemical Properties 7
Appearance:
Odor:
Odor Threshold:
p H:
Melting point/freezing paint:
Initial boiling point and boiling range:
Flash point:
Evaporation rate:
Flammability (solid, gas):
Upper/lower flammability or explosive limits: Not available
Vapor Pressure:
Vapor Density:
Relative Density:
Solubility:
Partition coefficient: n-octonol/water:
Auto -ignition temperature:
Decomposition temperature:
Viscosity:
Light to dark tan colored powder
Characteristic fermentation odor
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Soluble
Not available
Not available
Not available
Not available
Page2of3

Reactivity:
Chemical Stability:
Hazardous reactions:
Conditions to avoid:
Section 10: Stability and Reactivity
Not available
Stable under normal storage conditions
Not available
Not available
Incompatible materials: Nof available
Hazardous Decomposition Products: Not available
Section 11: Toxicological Information
Routes of Exposure:
Symptoms:
Immediate:
Delayed:
Acute toxicity:
Eye Irritation:
Skin Irritation:
Respiratory Irritation:
Sensitization towards product:
Germ cell mutagenicity:
Reproductive toxicity:
Carcinogenicity:
Eye contact, skin contact, ingestion, inhalation
May cause irritation to the eyes, skin, mucus membranes, and the
upper respiratory tract
Not available
Not available
May cause minor irritation
May cause minor Irritation
May cause minor irritation
There is no evidence of sensitizing potential
Not available
Not expected to produce reproductive toxicity
Not classified as a carcinogen by IARC, OSHA, or NTP
Section 1 2: Ecological Information
Ecotoxicity:
Persistence and degradability:
Bioaccumulative potential:
Mobility In soil:
Other adverse effects:
Not available
Product is readily biodegradable
Not available
Not available
Not available
Section 13: Disposal Considerations
Na special disposal method required, except that in accordance to all applicable federal, state, and
local regulations.
Harmonized Tariff Code:
UN Number:
UN Proper Shipping Name:
Transportation Hazard Class:
Packing Group:
Transport Environmental Hazard:
Transport Special Precautions:
MARPOL
Section 14: Transport Information
3002.90.10 (for Microbials)
Not classified
Not classified
Not classified
Not classified
Not classified
Not classified
Not classified
Section 15: Regulatory Information
AB components of this product are listed or exempt from listing on the TSCA InventoF f'
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 mode without warranty or
guarantee. Since the conditions of use ore 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 anoiyticol specifications. END OF SOS
Page 3 of 3

Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
✓,,,,,,,.--
\1-A-SR ] .... ·no ~
~OUP (~ ~• ~
Domino Foods, Inc.
According To Fe deral Registe,-I Vol n No. SB I Moriday, Ma rch 26 . 2012 / Rules and Regulaban n ~d A<ccrd,ng c the Ha,ardou, Product, Regulation (February 11, 2015)
SECTION 1: IDENTIFICATION
1.1. Product Identifier
Product Form: Substance
Product Name(s): Domino® Extra Fine Granulated, Fruit Granulated, Bakers Special Granulated, Standard Granulated, Medium
Granulated, Medium Fine Granulated, LCMT Granulated Sugar, Sanding No. 2, Superfine, Bottlers' Granulated Sugar, Canners' Extra
Fine Granulated and Con AA Sugar; C&H® Con A Sugar, Con AA Sugar, Coarse Sanding Sugar, Special Sanding Sugar, Con Sanding
Sugar, Special Coarse Sugar, Manufacturers Sugar, Special Grain Sugar, Extra Fine Granulated Sugar, Gel/Fruit Granulated Sugar,
Bottlers Extra Fine Granulated Sugar, Cube Sugar, and Bakers Special Sugar and 35/50 Granulated Sugar; USP/NF and EP grade of
any preceding product.
CAS No: 57-50-1
1.2. Intended Use of the Product
Sweetener
1.3. Name, Address, and Telephone of the Responsible Party
Company
American Sugar Refining Inc.
1 Federal Street
Yonkers, NY 10705
914-963-2400
1.4. Emergency Telephone Number
Emergency Number : 914-963-2400
SECTION 2: HAZARDS IDENTIFICATION
2.1. Classification of the Substance or Mixture
GHS-US/CA Classification
Comb. Dust
2.2. Label Elements
GHS-US/CA Labeling
Warning
May form combustible dust concentrations in air.
Signal Word (GHS-US/CA)
Hazard Statements (GHS-US/CA)
Supplemental Information Keep away from heat, hot surfaces, sparks, open flames and other ignition sources. No
smoking. Proper grounding procedures to avoid static electricity should be followed.
Avoid generating dust. Prevent dust accumulation (to minimize explosion hazard).
2.3. Other Hazards
Exposure may aggravate pre-existing eye, skin, or respiratory conditions.
2.4. Unknown Acute Toxicity (GHS-US/CA)
No data available
SECTION 3: COMPOSITION/INFORMATION ON INGREDIENTS
3.1. Substance
Name : Extra Fine Granulated Sugar
CAS No : 57-50-1
Name Product Identifier %*
Sucrose (CAS No) 57-50-1 100
3.2. Mixture
Not applicable
*Percentages are listed in weight by weight percentage (w/w%) for liquid and solid ingredients. Gas ingredients are listed in volume
by volume percentage (v/v%).
SECTION 4: FIRST AID MEASURES
4.1. Description of First-aid Measures
1/6
Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
General: Never give anything by mouth to an unconscious person. If you feel unwell, seek medical advice {show the label where
possible).
Inhalation: Using proper respiratory protection, immediately move the exposed person to fresh air. Obtain medical attention if
breathing difficulty persists.
Skin Contact: Rinse immediately with plenty of water for 5 minutes. Obtain medical attention if irritation develops or persists.
Eye Contact: Rinse cautiously with water for at least 5 minutes. Remove contact lenses, if present and easy to do. Continue rinsing .
Obtain medical attention if redness, pain, or irritation occurs.
Ingestion: Rinse mouth . Do not induce vomiting. Get medical advice and attention if you feel unwell.
4.2. Most Important Symptoms and Effects Both Acute and Delayed
General: Not expected to present a significant hazard under anticipated conditions of normal use. Prolonged contact with large
amounts of dust may cause mechanical irritation.
Inhalation: Dust may be harmful or cause irritation.
Skin Contact: Prolonged exposure may cause skin irritation.
Eye Contact: May cause slight irritation to eyes.
Ingestion: Ingestion is not likely to be harmful or have adverse effects .
Chronic Symptoms: Repeated or prolonged contact with skin may cause dermatitis.
4.3. Indication of Any Immediate Medical Attention and Special Treatment Needed
If exposed or concerned, get medical advice and attention . If medical advice is needed, have product container or label at hand.
SECTION 5: FIRE-FIGHTING MEASURES
5.1. Extinguishing Media
Suitable Extinguishing Media: Use extinguishing media appropriate for surrounding fire.
Unsuitable Extinguishing Media: Do not use a heavy water stream . Use of heavy stream of water may spread fire.
5.2. Special Hazards Arising From the Substance or Mixture
Fire Hazard: Combustible Dust.
Explosion Hazard: Dust explosion hazard in air.
Reactivity: Hazardous reactions will not occur under normal conditions .
5.3. Advice for Firefighters
Precautionary Measures Fire: Exerc ise caution when fighting any chem ical fire.
Firefighting Instructions: Use water spray or fog for cooling exposed conta iners.
Protection During Firefighting: Do not enter fire area without proper protective equipment, includ ing respiratory protection.
Hazardous Combustion Products : Thermal decomposition generates : Carbon oxides {CO, CO 2 ).
Other Information: Risk of dust explosion .
Reference to Other Sections
Refer to Section 9 for flammability properties.
SECTION 6: ACCIDENTAL RELEASE MEASURES
6.1. Personal Precautions, Protective Equipment and Emergency Procedures
General Measures: Avoid prolonged contact with eyes, skin and clothing . Avoid generating dust. Avoid breathing dust. Remove
ignition sources . Keep away from heat, hot surfaces, sparks, open flames, and other ignition sources. No smoki ng.
6.1.1. For Non-Emergency Personnel
Protective Equipment: Use appropriate personal protective equipment {PPE).
Emergency Procedures: Evacuate unnecessary personnel.
6.1.2. For Emergency Personnel
Protective Equipment: Equip cleanup crew with proper protection .
Emergency Procedures: Upon arrival at the scene, a first responder is expected to recognize the presence of dangerous goods,
protect oneself and the public, secu re the area, and call for the assistance of trained personnel as soon as conditions permit.
Venti late area.
6.2. Environmental Precautions
Prevent entry to sewers and public waters .
6.3. Methods and Materials for Containment and Cleaning Up
For Containment: Contain solid spills with appropriate barriers and prevent migration and entry into sewers or streams . Avoid
generation of dust during clean -up of spills.
2/6
Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
Methods for Cleaning Up: Clean up spills immediately and dispose of waste safely. Vacuum clean-up is preferred. If sweeping is
required use a dust suppressant. Use explosion proof vacuum during cleanup, with appropriate filter. Do not mix with other
materials. Use only non-sparking tools. Contact competent authorities after a spill.
6.4. Reference to Other Sections
See Section 8 for exposure controls and personal protection and Section 13 for disposal considerations.
SECTION 7: HANDLING AND STORAGE
7.1. Precautions for Safe Handling
Additional Hazards When Processed: Accumulation and dispersion of dust with an ignition source can cause a combustible dust
explosion. Keep dust levels to a minimum and follow applicable regulations.
Precautions for Safe Handling: Wash hands and other exposed areas with mild soap and water before eating, drinking or smoking
and when leaving work. Avoid prolonged contact with eyes, skin and clothing. Avoid creating or spreading dust. Avoid breathing
dust. Keep away from heat, sparks, open flames, hot surfaces. -No smoking.
Hygiene Measures: Handle in accordance with good industrial hygiene and safety procedures.
7.2. Conditions for Safe Storage, Including Any Incompatibilities
Technical Measures: Comply with applicable regulations. Avoid creating or spreading dust. Use explosion-proof electrical,
ventilating, lighting equipment. Proper grounding procedures to avoid static electricity should be followed.
Storage Conditions: Keep container closed when not in use. Store in a dry, cool place. Keep/Store away from direct sunlight,
extremely high or low temperatures and incompatible materials.
Incompatible Materials: Strong acids, strong bases, strong oxidizers. Sulfuric acid. Nitric acid.
7.3. Specific End Use(s)
Sweetener
SECTION 8: EXPOSURE CONTROLS/PERSONAL PROTECTION
8.1. Control Parameters
For substances listed in section 3 that are not listed here, there are no established Exposure limits from the manufacturer, supplier,
importer, or the appropriate advisory agency including: ACGIH (TLV), AIHA (WEEL), NIOSH (REL), OSHA (PEL), Canadian provincial
governments, or the Mexican government.
Sucrose (57-50-1)
Mexico OEL TWA (mg/m3 ) 10 mg/m3
Mexico OEL STEL (mg/m3 ) 20 mg/m3
USAACGIH ACGIH TWA (mg/m3 ) 10 mg/m3
USAACGIH ACGIH chemical category Not Classifiable as a Human Carcinogen
USA OSHA OSHA PEL (TWA) (mg/m 3 ) 15 mg/m3 (total dust)
5 mg/m3 (respirable fraction)
USANIOSH NIOSH REL (TWA) (mg/m3 ) 10 mg/m3 (total dust)
5 mg/m3 (respirable dust)
Alberta OEL TWA (mg/m3 ) 10 mg/m3
British Columbia OEL TWA (mg/m 3 ) 10 mg/m3 (total dust)
3 mg/m3 (respirable fraction)
Manitoba OEL TWA (mg/m3 ) 10 mg/m3
New Brunswick OEL TWA (mg/m3 ) 10 mg/m3
Newfoundland & Labrador OEL TWA (mg/m3 ) 10 mg/m3
Nova Scotia OEL TWA (mg/m3 ) 10 mg/m3
Nunavut OEL STEL (mg/m3 ) 20 mg/m3
Nunavut OEL TWA (mg/m3 ) 10 mg/m3
Northwest Territories OEL STEL (mg/m3 ) 20 mg/m3
Northwest Territories OEL TWA (mg/m3 ) 10 mg/m3
Ontario OEL TWA (mg/m 3 ) 10 mg/m3
Prince Edward Island OEL TWA (mg/m 3 ) 10 mg/m3
Quebec VEMP (mg/m 3 ) 10 mg/m3
Saskatchewan OEL STEL (mg/m3 ) 20 mg/m3
Saskatchewan OEL TWA (mg/m 3 ) 10 mg/m3
3/6
Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
Yukon OEL STEL (mg/m3 ) 20 mg/m3
Yukon OEL TWA (mg/m 3 ) 30 mppcf
10 mg/m3
8.2. Exposure Controls
Appropriate Engineering Controls: Emergency eye wash fountain capability should be available in the immediate vicinity of any
potential exposure. Ensure adequate ventilation, especially in confined areas. Ensure all national/local regulations are observed.
Proper grounding procedures to avoid static electricity should be followed. Use explosion-proof equipment. Use local exhaust or
general dilution ventilation or other suppression methods to maintain dust levels below exposure limits. Power equipment should
be equipped with proper dust collection devices. It is recommended that all dust control equipment such as local exhaust ventilation
and material transport systems involved in handling of this product contain explosion relief vents or an explosion suppression
system or an oxygen-deficient environment. O°'Oii"'O clothing. Pmtecti,e goggles. losoffident ventHatlo"' wea, cespicatocy prntection.
Materials for Protective Clothing: Chemically resistant materials and fabrics.
Hand Protection: Wear protective gloves.
Eye Protection: Chemical safety goggles.
Skin and Body Protection: Wear suitable protective clothing.
Respiratory Protection: If exposure limits are exceeded or irritation is experienced, approved respiratory protection should be worn.
In case of inadequate ventilation, oxygen deficient atmosphere, or where exposure levels are not known wear approved respiratory
protection.
Other Information: When using, do not eat, drink or smoke
SECTION 9: PHYSICAL AND CHEMICAL PROPERTIES
9.1. Information on Basic Physical and Chemical Properties
Physical State Solid
Appearance
Odor
Odor Threshold
pH
Evaporation Rate
Melting Point
Freezing Point
Boiling Point
Flash Point
Auto-ignition Temperature
Decomposition Temperature
Flammability (solid, gas)
Lower Flammable Limit
Upper Flammable Limit
Vapor Pressure
Relative Vapor Density at 20°c
Relative Density
Specific Gravity
Solubility
Partition Coefficient: N-Octanol/Water
Viscosity
SECTION 10: STABILITY AND REACTIVITY
Dry powder, granules
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
Not available
10.1. Reactivity: Hazardous reactions will not occur under normal conditions.
4/6
Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
10.2. Chemical Stability: Stable under recommended handling and storage conditions (see section 7).
10.3. Possibility of Hazardous Reactions: Hazardous polymerization will not occur.
10.4. Conditions to Avoid: Direct sunlight, extremely high or low temperatures, and incompatible materials. Sparks, heat, open
flame and other sources of ignition. Dust accumulation (to minimize explosion hazard).
10.5. Incompatible Materials: Strong acids, strong bases, strong oxidizers. Sulfuric acid. Nitric acid.
10.6. Hazardous Decomposition Products: None known.
SECTION 11: TOXICOLOGICAL INFORMATION
11.1. Information on Toxicological Effects -Product
Acute Toxicity (Oral): Not classified
Acute Toxicity (Dermal): Not classified
Acute Toxicity (Inhalation): Not classified
LD50 and LC50 Data: Not available
Skin Corrosion/Irritation: Not classified
Eye Damage/Irritation: Not classified
Respiratory or Skin Sensitization: Not classified
Germ Cell Mutagenicity: Not classified
Carcinogenicity: Not classified
Specific Target Organ Toxicity (Repeated Exposure): Not classified
Reproductive Toxicity: Not classified
Specific Target Organ Toxicity (Single Exposure): Not classified
Aspiration Hazard: Not classified
Symptoms/Injuries After Inhalation: Dust may be harmful or cause irritation.
Symptoms/Injuries After Skin Contact: Prolonged exposure may cause skin irritation.
Symptoms/Injuries After Eye Contact: May cause slight irritation to eyes.
Symptoms/Injuries After Ingestion: Ingestion is not likely to be harmful or have adverse effects.
Chronic Symptoms: Repeated or prolonged contact with skin may cause dermatitis.
11.2. Information on Toxicological Effects -lngredient(s)
LD50 and LCS0 Data:
Sucrose (57-50-1)
LD50 Oral Rat 29700 mg/kg
SECTION 12: ECOLOGICAL INFORMATION
12.1. Toxicity
Ecology -General: Not classified.
12.2. Persistence and Degradability
Extra Fine Granulated Sugar (57-50-1)
Persistence and Degradability Not established .
12.3. Bioaccumulative Potential
Extra Fine Granulated Sugar (57-50-1)
Bioaccumulative Potential Not established.
12.4. Mobility in Soil Not available
12.5. Other Adverse Effects
Other Information: Avoid release to the environment.
SECTION 13: DISPOSAL CONSIDERATIONS
13.1. Waste treatment methods
Waste Disposal Recommendations: Dispose of contents/container in accordance with local, regional, provincial, territorial, national,
and international regulations
Additional Information: Container may remain hazardous when empty. Continue to observe all precautions.
Ecology -Waste Materials: Avoid release to the environment.
5/6
Safety Data Sheet
All White Granulated Sugars
Revision Date 12/22/2016 Version 1.0
SECTION 14: TRANSPORT INFORMATION
The shipping description(s) stated herein were prepared in accordance with certain assumptions at the time the SDS was authored,
and can vary based on a number of variables that may or may not have been known at the time the SDS was issued.
14.1. In Accordance with DOT Not regulated for transport
14.2. In Accordance with IMDG Not regulated for transport
14.3. In Accordance with IATA Not regulated for transport
14.4. In Accordance with TDG Not regulated for transport
SECTION 15: REGULATORY INFORMATION
15.1. US Federal Regulations
Extra Fine Granulated Sugar (57-50-1)
SARA Section 311/312 Hazard Classes
j
Fire hazard
Sudden release of pressure hazard
Sucrose (57-50-1)
Listed on the United States TSCA (Toxic Substances Control Act) inventory
15.2. US State Regulations
Sucrose (57-50-1)
U.S. -Massachusetts -Right To Know List
U.S. -Pennsylvania -RTK (Right to Know) List
15.3. Canadian Regulations
Sucrose (57-50-1)
Listed on the Canadian DSL (Domestic Substances Li st
SECTION 16: OTHER INFORMATION, INCLUDING DATE OF PREPARATION OR LAST REVISION
Revision Date
Other Information
12/22/2016
This document has been prepared in accordance with the SDS requirements of the OSHA
Hazard Communication Standard 29 CFR 1910.1200 and Canada's Hazardous Products
Regulations (HPR).
This information is based on our current knowledge and is intended to describe the product for the purposes of health, safety and
environmental requirements only. It should not therefore be construed as guaranteeing any specific property of the product.
NA GHS SDS 2015 (US, Can, Mex)
6/6
UNDEVELOPED
GRASS
MW-12
GRASS ''•
MW-14R
TX,
MW-14R
ASPHALT
Rostwooa LAN
MW-1 6
NS
Anticipate invoicing late August 2020
M W-21
FORMER
REHOUSE
5,000 ug/L
50 ug/L
24,100
12,300
GRASS
MW-17R
11,500
11,700
MW-19
RESIDENTIAL
MW-15
ASPHALT
GRASS
ASPHALT
GRASS
GRASS
Legend
0
Property Line
Adjacent Property Line
Right —of —Way
Fence Line
Former UST System
Existing Monitoring Well
6errzene Isacancenlra ion Linz
£i3B ISacancentrafion Lira?
CoC
2L
GCL
Benzene
1
5,000
Toluene
600
260,000
Ethyl benzene
600
84,500
Xylenes
500
85,500
MTBE
20
20,000
1,2-DCA
0.4
400
EDB
0.02
50
General Notes:
Mop adapted from Gaston County GIS & Excel
figure dated 1/21/14
Structure locations are approximate
UST — Underground Storage Tank
All concentrations measured in
micrograms per liter (ug/L)
Constituent concentrations ore based
on samples collected 07/09/19
Data fn bold exceeds 2L, highlight exceeds GCL
an samples collected 07/09/19
BDL — Befow Laborotory ➢tection Limits
E0 — Ethylene ❑ibromide
GCLs — Gross Contamination Levels
NF — Not Found
ATC
7609 Whitehall Executive Censer Drive, Saito 600
Charlotte, North Carolina 26273
rhea.: (7U4 -sloe Fro t704l626-3272
-ice
(Former) Pepsi Facility
i462 West Airline Avenue
Gastonia, Gaston County, NC
TELE
Groundwater Analytical Results Map
CLEW:
Bottling Group, LLC
mew scke
so 1s 0 15 as
CONWER CAME
DRAWN 9Y:
DESIGN 9Y:
CHECKED BY:
APPROVED UT':
LB
TWG
MOS
MOS
SCALE:
oATE:
uoe NO.
FIGURE N0.:
= 30.
02/28/2020
199PEP1902
4

UNDEVELOPED
GRASS
MW-1
( 7.3 ors}
GRASS
1Fs
44z'4'F41,
RECEIVED
°roCOO c
Rost -woo° L4N
F
Hydraulic gradient calculated to be approximately
0.0069 fee& foot between wells MW-14R and MW-17R
FORMER
OFFICE & MANUFACTURING
(72.64)
MW-1
'+(-72.22)
MW-14R
(73.14) G5 ASPHALT
-o
MW-16
(72.53)0
FORMER
GARAGE & WAREHOUSE
MW-7R
ia (72.49)
72,98)
GRASS
MW-19
(72.27)
RESIDENTIAL
ASPHALT
MW-18
(71.79)
GRASS
GRASS
GRASS
Legend
Property Line
Adjacent Property Line
Right —of —Way
■ 1, — Fence Une
Former UST System
Q, Monitoring Weil
6E _ 21) Groundwater Elevation
Groundwater Elevation Contour
(Dashed Where Inferred)
Groundwater Flow Direction
General Notes:
Mop adopted from Gorton County GIS & Excel
figure dated 1/21/14
Structure locations are approximate
UST — Underground Storage Tank
Groundwater elevations ore relative to a
temporary benchmark with on assumed
datum of 100.00 feet above mean sea level.
Groundwater elevations ore based on
measurements made on 07/09/2019.
Water table contours and flow directions
assume homogenous, isotropic aquifer
conditions and horizontal flow
Monitoring Well MW-13 not used to determine
groundwater elevation contours.
;ETC
7eoe'Whitehall Executive venter Drive. Suite S00
P North �$93
aWn[r':
(Former) Pepsi Facility
1462 West Airline Avenue
Gastonia, Gaston County, NC
Groundwater Elevation Contour Map
Bottling Group, LLC
30 15 0 13 30
ea,PUThR CADRE ,
ORANN arc
L3
DESIGN an
TWG
CHECKED eY:
MOS
WPAOVED We;
PADS
1�= 30'
aiE
09/04/19
Ja® NO.:
199PEP1901
MORE NO.:
3