WI0400242_DEEMED FILES_20131210

''•\~~---
t/--\-~" INJECTION EVENT RECORD :::r: •
North Carolina Department of Environment and N~tural Resources-Division o·f. Wate·r.Quality}
/
Permit Number Po;i;mJettea by==Rt.rre ~ ro ~':, a;,,. J
----------------------~
1. Permit Information
ExxonMobil Corporation
Pennittee
Former ExxonMobil Retail Facility #42650
Facility Name
2415 Maple Avenue, Burlington, North Carolina
Facility Address
2. Injection Contractor Information
ARCADIS G&M of North Carolina, Inc.
Injection Contractor I Company Name
StreetAddress 801 Corporate Center Dr. #300
Raleigh NC 27607
City State Zip Code
~ 854-1282
Area code -Phone number
3. Well Information
Number of wells used for injection __ 3 ___ _
Well names INJ-1, INJ-2, MW-4/INJ-3
Were any new wells installed during this injection
event?
1K] Yes O No
If yes, please provide the following information:
1 Number of Monitoring Wells -------
2 Number of Injection Wells --------
Type of Well Installed (Check applicable type):
[R] Bored O Drilled D Direct-Push
D Hand-Augured O Other (specify) ----
Please include two copies of form GW-lbfor each
well installed.
Were any wells abandoned during this injection
event?
D Yes [R] 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. lnjectant Information
Sodium Persulfate and Ferrous Sulfate/ Citric Acid
lnjectant Type
Sodium Persulfate (95%) -so-190 g/L
Concentration Ferrous Sulfate / Citric Acid (5%) -2. 5 g/L
If the injectant is diluted please indicate the source
dilution fluid. Municipal Water (City of Burlingto
Total Volume Injected 1, 680-gallons
Volume Injected per well From 2ao to aao-gallons
5. Injection History
Injection date(s) December 2 -5, 2013
Injection number (e.g. 3 of 5) 1 of 2 (e·stimated)
Is this the last injection at this site?
D Yes ~ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM rs CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
STANDARDS LAID OUT IN THE PERMIT.
SIGNATURE OF INJECTION CONTRACTOR DATE
Keith Carr & Salina Adams
PRINT NAME OF PERSON PERFORMING THE INJECTION
Submit the original of this form to the Division of Water Quality within 30 days of injection. Form UIC-IER
Rev. 07/09 Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-733-3221
'2ARCADIS
i~fi,1.~t .i1(f~re · ~~1,::ter fq~uori';h~hr-i1i.,ifdi!J1s
Attn : Ms. Sherri Knight
C/O: Mr. Michael Rogers
NCDENR -Division of Water Quality
Aquifer Protection Section -UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Subject
Injection Performance Record
Former ExxonMobil Facility #42650
2415 Maple Avenue
Burlington, Alamance County, NC
Incident Number: 9416
Dear Ms. Knight:
On behalf of ExxonMobil Environmental Services (EMES), ARCADIS G&M of North
Carolina, Inc. (ARCADIS) is submitting an Injection Performance Record to the North
Carolina Department of Environment and Natural Resources (NCDENR) Division of
Water Quality -Aquifer Protection Section Underground Injection Control (UIC) Program
for former ExxonMobil facility #42650 located in Burlington, Alamance County, North
Carolina.
ARCADIS submitted a Notification of Intent to Construct or Operate Injection Wells
for review and approval on July 1, 2013 for the injection of sodium persulfate utilizing
ferrous sulfate heptahydrate and citric acid as activators at injection well locations
INJ-1 , INJ-2, and MW-4/INJ-3 .
On October 15-16, 2013, ARCADIS subcontracted Geologic Exploration Inc. (GEX)
to install one (1) groundwater monitoring well, MW-11, and two (2) chemical injection
wells, INJ-1 and INJ-2. The location and construction of the groundwater monitoring
and chemical injection wells was completed as per the July 1, 2013 Notification of
Intent to Construct or Operate Injection Wells Form.
On the evenings of December 2 -5, 2013 ARCADIS personnel completed a sodium
persulfate injection utilizing ferrous iron and citric acid as activators as follows:
Ima g ine the result
ARCADIS G&M of North Carolina,
Inc.
801 Corporate Center Drive
Suite300
Raleigh
North Carolina 27607
Tel [phone]
Fax [phone]
www.arcadls-us.com
Environment
Date :
December 10, 2013
Contact:
Scott Bostian
Phone :
919.415.2291
Email:
Scott. Bostian@arcadis-
us.com
Our ret
80085851.0028
ARCADIS G&M of North Carolina,
Inc.
NC Engineering License# C-1869
NC Surveying License# C-1869
ARCADIS
• Approximately 240 gallons of the sodium persulfate (100 g/L} and 40 gallons
of the ferrous sulfate heptahydrate/citric acid mixture was injected into
injection well lNJ-1.
• Approximately 280 gallons of the sodium persulfate (120 gallons at 50 g/L
and 160 gallons at 100 g/L) and 240 gallons of the ferrous sulfate
heptahydrate/citric acid mixture was injected into injection well lNJ-2.
• Approximately 440 gallons of the sodium persulfate (360 gallons at 50 g/L
and 80 gallons at 100 g/L) and 440 gallons of the ferrous sulfate
heptahydrate/citric acid mixture was injected into injection well MW-4/INJ-3.
In total, approximately 1,680 gallons of the sodium persulfate and ferrous sulfate
heptahydrate/citric acid mixture was injected at the site on the evenings of December
2 -5, 2013. An injection event record is included as Appendix A. Two copies of
Form GW-1 B for monitoring well MW-11 and chemical injection wells INJ-1 and INJ-2
are included as Appendix B.
ARCADIS will conduct two monthly post-injection groundwater monitoring and
sampling events in January 2014 and February 2014 as specified in the approved
Notification of Intent to Construct or Operate Injection Wells dated July 1, 2013. A
report detailing the findings of the January 2014 and February 2014 groundwater
monitoring and sampling events will be submitted to both the NCDENR Division of
Water Quality -Aquifer Protection UIC Program and the NCDENR Division of Waste
Management -Underground Storage Tank (UST) Section for review and approval
within 45 days of receipt of the February 2014 groundwater laboratory analytical
report.
Sincerely,
ARCADIS G&M of North Carolina, Inc.
Scott Bostian, P.E.
Senior Engineer
Jon Farley, P.E.
Certified Project Manager I
Ms. Sherri Knight
Mr. Michael Rogers
December 10, 2013
Page:
2/3
ARCADts ·
Appendix A -Injection Event Record -December 2 -5, 2013
Appendix B -Form GW-1 B for MW-11, INJ-1, and INJ-2 (Two Copies)
Copies:
Ms. Jewel Cox -EMES
Mr. Waddell Waters -NCDENR UST Section -Winston-Salem Regional Office
File -EM 42650
Ms. Sherri Knight
Mr. Michael Rogers
December 10, 2013
Page:
3/3
WELL CONSTRUCTION RECORD
This form can be used for single or multiple wells
1. Well Contractor Information:
VINCE FEDERLE
Well Contactor Nam
A - 3552
NC Wen Contractor Certiticaiios: Number
GEOLOGIC EXPLORATION, INC
Company Nome
2, Well Construction Permit #:
List all aisidtcahle well mrirrrurNon permits (i.e. Camay, Soak, Variance. eta)
3, Well Use (check well use):
Water Supply Well:
°Agricultural
❑ Geothermal (HeatingiCooling Supply)
©lnduslria (/Commercial
°Irrigation
❑Municipal/Public
OResideitial Water Supply (single)
°Residential Water Supply (shared)
Non -Water Supply Weill
[Monitoring
Injection Weib
❑ Aquifer Recharge
❑ Aquifer Storage and Recovery
❑Aquifer Test
❑ Experimental Technology
❑ Geothermal (Closed Loop)
❑Recovery
©Groundwater Remediation
[]Salinity Barrier
❑Stormwater Drainage
IJSubsidence Control
[]Tracer
['Geothermal (Heating/Coaling Return) pother (explain under #21 Remarks)
4. Date Well(s) Completer]: 10/15i13 Well MN 1 NJ-1
Sa. WcII Location:
EXXONM 08I L - 42650
FecitilylOwacrName Facility JOY (if applicable)
2415 MAPLE AVENUE BURLINGTON 27215
Physical Address, City, and Zip
ALAMANCE
Comity Parcel 'Identification No. MIN)
Latitude and Longitude in degreesiminutcslsecunds or decimal degrees:
(if well field, one ladlnng is sufficient)
36" 03' 56.48" N 79° 25' 48.96" ►v
6. is (are) the welt(s): OPermencnt or ❑Temporary
7. Is this a repair to an existing well; ❑Yes or 173No
{/this rr n repair, fill orb knout; well construction li fnnpmerruu and explahr the ordure of the
repair under r121 n±irrrrrlcr 6edrair or on the back grams form.
S. Number of wells constructed: 1
.rnhnilr oneformr.
Far mmrllrple injection ar rmH-nnrorsnooty trdlr ONLY mph the same corrstrncrfrn, yno era:
9. Total well depth below land surface: 27.0
FarmirrINplc war NO all dcpNrx i ryfe cru (ono ale- 3@200'nod 2 r@f00')
10. Static water level below tap of casing: 20.0 (ff.)
If trtorer level IA nlowe easing. era "4-
11. Borehole diameter: _ $•0 (in.)
AUGER
12. Well construction method:
(ft.)
(i.e. auger, rotary, cable, direct push, etc:-)
FOR WATER SUPPLY WELLS ONLY:
13a. 'Yield (gpm) Method of test:
I3b. Disinfection type: Amount
Fur Internal Use ONLY:
rRAAI
To
oEscHtrTIoN
rt.
rt.
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15. OUTER
CASING (for
multi-csud weld Olt LINER (it applicable)
FROM
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itrAMETEtr TIOCKNFSE
MATERIAL
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DIAMETER
THICKNESS
MATERIAL
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SCH 40
, PVC
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.
• IltStFlEEN
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SLOT SIZE
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EMPLICF.MENTMET11OD & AMOUNT
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SLURRY
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R.
ft
WANtiffiltenrktAtito
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FROM
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MATERIAL
T FM1'I.ACitmENT METHOD
15.0 fi•
27.0 r<
20-40
FINE SiLICA SAND
rt.
n.
20. DRILLING LOG Welch additional sheets irmrxessary}
FRorti
To
or -scowl -ton trader, fioTdnrw caiIRo[kr ,Lc, train La.,. cer.J
0.0 0•
1.0
ASPHALT/GRAVEL
1.0 ft-
27.0 rr.
BROWNiRE] SANDY SILT
rt.
rt.
rt.
rt.
n.
Ft.
rt.
ft_
ft,
rt.
,. `Tf. tiEM Roc .-
BENTONiTE SEAL FROM 13.0 TO 15.0 FEET
22. 17illea v
Signature oMortified WcII Contractor
10/24/13
Dart
fly signing ibis .than, I hereby cerr/, dial Nee trcff(sj apt (were) column -me Inn ncrurrlm'rcr
with 1M ACi1C 02C ,0100 or 1.1.4 NCAC 02C .0204 iVel1 Coirtrncline Stw,ikintr arrd Owe n
coyly ufrhis reword has Garin piim•klud in the well owner.
23. Site diagram or ndclitional well details:
You may use the back of this page to provide additional welt site details or well
Construction details. You may also attach additional pages if necessary_
SUIIMITTAL [NSTUCTIONS
24a. Far All WciIs: Submit this form within 30 days of completion of well
construction to the following
Division or Writer Quality, Information Processing Unit,
I6I7 Mail Service Center, Raleigh, NC 27699-1617
24h, For irijcetion Wells: In addition to sending the form to the address in 24a
above, also submit a copy of this fort within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Suotniv & injection Wells; in addition to sending the fnmt to
the address(es) above, also submit one copy of this fort within 30 days of
completion of well construciiori to the county health department of the county
where constructed.
FPrin G W- t
North Carolina Dcparamern or Environment and Natural Resources- Division aF Water Quality Revised hit. 2013

WELL CONSTRUCTION RECORD
Thu form can be ured for single or multiple wells
I. Well Contractor Information:
VINCE FEDERLE
Weft Contractor Namc
A - 3552
NC Welt Contractor Certification Number
GEOLOGIC EXPLORATION, INC
Co,apargr Nnnrc
2. Well Construction Permit it:
l.lai ell alrytlleable ire 0 carrriructiam porgies 0.a. Camay, Slane, liana wu. arc)
3. Well Usc (cheek well use):
Water Supply Well:
❑ Agricultural
❑ Geothermal (Heating/Cooling Supply)
i lIndus4iaLICommercial
['irrigation
❑ MunicipalfPubiic
❑ Residcntiat Water Supply (single)
❑ Residential Water Supply (shared)
Non -Water Supply Well
RMonitonng °Recovery
isijection Well;
°Aquifer Recharge
❑Aquifer Storage and Recovery
°Aqui fer Test
47Expairnenm' Technology
°Geothermal (Closed Loop)
°Geothermal (fleating/Cnoling Return)
lf7Groundwater Renlediation
['Salinity Barrier
u Stormwntcr drainage
❑Subsidence Control
°Tracer
❑Ddter (explain under 421 Remarks)
4. DateWell(s) Completed: 1 0/15ji Well [DII
5R. Well Location:
EXXONMOBIL - 42650
I NJ-2
Facility/Owner Name Facility tifii (if applicable)
2415 MAPLE AVENUE BURLINGTON 27215
Physical Address, City, and Zip
ALAMANCE
County Parcel Identification No, (MN)
5L Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if we11 retd, ai a iaNrntg is suffreierrt)
35U 03' 55.58" 79' 25' 48,94"
6_ Is (arc) thewcll(s): 1JJPennanent or ❑Tcmparnry
7. is this a repair to an existing well: ❑Yes or EtNo
ram is a r apmtr, full arm 1p,nn 11'dlf c , ,s/nacho r Naarm avian mill explain the aware of Ma
repair mkt 421 rrnmrirsertia I or Oil /be bard nfihlr
E. Nurrthr:r of wells constructed: 1
Far unrhiple Nimifort err runs-nrldrrmpply nelir ONL 1' with Ma mair em4,Yrud4,o, yam care
salmon fate ',MIL
9. Tutati well depth below Iand surface: 27.0 Or)
Far mold* beets lfri rrlldap*? Jelddrma (ermapla- 3 rQ200' mm1431001
1 Q. Static outer level below lop °Teasing: 20.0
1f Wafer leydl l8 nbnHC Ming, m re "4"
E I. Borehole diameter: 8.0 (in.)
AUGER
12. Well ennstructiun ruetllod:
{1.e. enact. teary. cabin, direct welt. etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (pm) Method of test
13h. Disinfection type: AMR oak
For Intenrrl Use ONLY
I4: WATta2DNFS
FROM
7n
DESCRIPTION
rt.
H.
rL
rL
15. O11'L'PR CASINE:{16c_mulHxssed4kdfe}
OR LINER (if tip livable)
FROM
TO
DIAMETER
THICKNESS
MATERIAL
R.
rt.
in.
16:JNNER C: UM % OR'E
• I.N6 lg!hid oaalp[osrJl-loapl
FIOM
TO
DIAMETER
THICKNESS
MATERIAL
0.0 n
17-0 it.
2.0 in.
SCH 40
PVC
fL
fL
fa.
17. SCREEN
FROM
TO
DIAMETER -
SLOT SIZE
TII CKNESS
MATERIAL
17.0 fL
27.0 ft.
2.0 ice-
.020
SCH 40
PVC
R.
rt.
in.
I(Qt
FROM TO
MMATEIt1AL
EMPLACEMENT AlE 1 0D & AMOUNT
0.0 ft.
13.0 IL
PnnaArrarwrrwnt
SLURRY
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fr.
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19. MN I e
• Vl$L.PA.G+lt
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FROM
TO
MATERIAL
EMPLACEMENT idET11OD
15.0 Th
27.0 fr.
20-40
FINE SILICA SAND
rt.
fL
20. 1)R1LL1NG
LOG launch additional sheets if Aecrs$rryl
FRO AI
TO
DESCRIPTION (rate., bardncx, sane, aria Iyyr,srafn rlrr. es.a
0,0 ft'
1.0 IL
TOPSOIL
1.0 ft.
27.0 fL
BROWNiRED SANDY SILT
ft.
rL
ft.
It
tr.
fr.
_
IL.
FL
ft. rL
• 2(.1113MA:10a
BENTONITE SEAL FROM 13.0 TO 15.0 FEET
10/24/13
Signature orCorlifrcd Wd1 Cnruractur Ihtc
By signing ibis foray, 1 hereby certgi. dial the well(;) was (here) coma icf d Ili accorrlorrcc
w ith l.5A NOW 02C .Akin nr 1SA NCAC 02C .0200 Well Camtrrichwl &wrdurdr wed Mat
u o/J, alibis record has bean pookled to the wall owner:
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if netxssary.
StJ (1M ITTA L INSTUCTI ONS
241I. For All Wells: Submit this form within 30 days of completion of well
construction to the following;
Division of Water Quality, Information Processing Unit,
1617 MRii Service Center, Raleigh, NC 27699-1617
24b. For Injection Welk: in addition to sending the form to the address in 24a
above, also submit a copy of this Fenn within 30 days of completion of' well
construction to the futlowing-
Division or Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24e. For Water Smutty & lniection Wells: in addilion to sending ilia form to
the addresses) above, also submit one copy of this funn within 30 days of
completion of well construction to the county health department of the county
where constructed_
Form OW-1
Nod h Crtroliim ar ratnneui of Environment and Natural Re owceg-Division ofWorer Quality Revised Jail, 2013

WELL CONSTRUCTION RECORD
'Gins form can be used far single °r rnuttiplr wells
1. Well Contractor Information:
VINCE FEDERLE
Well Contractor Name
A - 3552
NC Well Contractor Caeificei an Numl.nr
GEOLOGIC EXPLORATION, INC
Fur Internal Lae ONLY:
«VA`ifi 2CINES
moat
Tn
punt
rt.
R
rt.
rL
11,.33 KEER.ltiGSINt i(tdr nieftl easal,wells) OR LINER (tf ip linable)
Tnlf•l:AirSS MATERIAL
FROM
r.
TO
DIAMETER
a.
Compii y Nnme
2. Well Construction Permit1:
Liar oil applicable wdl carrrrucvWn porinlis (l.r. Crimp, Stoic, Forimrcc. inc)
3. Well Use (check well use):
Water Supply Well:
❑ Agricultural
❑Geothermal (Heating/Cooling Supply)
❑ i nd ustri ullConunercial
❑ irrigation
❑Municipal/Public
❑ Residential Water Supply (single)
❑ Residential Water Supply (shared)
Noir-Water Supply Welt:
tiManitoring ❑Recovery
Injection Well:
OAquifer Recharge
❑Aquifer Storage and Recovery
DAqu ifer Test
❑ Experimental Technology
❑ Geottiermnl (Closed Loop)
❑ Geothermal (Heating/Cooling Return)
°Groundwater Remediation
❑Salinity Barrier
DStonmvater Drainage
['Subsidence Control
DTracer
°Other (explain under021 Remarks)
4. Date Well(s) Completed: 1 D!15113 Welt JD#
SR. Weil Location:
EXXONMOBIL - 42650
MW-11
FaciiirytOwn -Nurnc Facility Intl (ifapplicuble)
2415 MAPLE AVENUE BURLINGTON 27215
Physical Address, City. and Zip
ALAMANCE
County Parcel Identification No. (PIN)
fib. Latitude and Longitude in degrees/minutes/seconds or decimal degrees;
[iftirell Nei d, one !oblong is soflicicnt)
36° 03' 56.65" N 79° 25' 49.20"
6. Is (arc) the well(s): I22lPcrmnncnt or ❑Temporary
W
7, Is this it repair to an existing ❑Yes or ElNNo
INNA is a re air, fluor: imo„vi hvvii crul intcliau lif/urruaiiaa and ucpinirr the rHiliui of nk
rvpalr currier 021 n!urarks srcriat ur air !be hark (60) 4s furor.
9. Number of wells constructed:
Fornruirlpk irrjurriau Far• non -water si ly+fy wells ONf.Y,rith the.r,wa cunslrwellau, ynrr con
ration nun farm.
J. Total well depth below land surface: 27.0
Far Multiple mils far all dcpilrx ofdijfrrerrr (example- 3 ,,200' and 2rr@i l00')
10. Static wirier level below hip ufcasing: 20 0
if %mrer hoof is above casing, ruse "+"
1I. Borehole diameter: 8-0 on.)
12. Well construction method: AUGER
(ft.)
(ft.)
(i.c. nutter, rotary. noble, direct posh, ere.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm)
13b. Disinfection type;
Method of test
Amount:
t4.INNI1R.C.XSD Gi'GR TL/IIII(gltaoi5erraaf close lour 1
FROM
'TO
DIAMETER
IIUCICNESS
MATERIAL
0.0 R.
17.0 ri.
2.0
SCH 40
PVC
R.
re.
1a.
17/. ttMEER•
FROM
TO
umattrim t SLOT SIZE 77I10ENESS
MATERIAL
17.0 It
11.
27.0 R-
rt.
2.0 . in.
,010
SCH 40
PVC
mom
TO
MATERIAL
EMPLACEMENT METHon & AM OUNT
0.0 R
13.0
raRrrwrasMrmnsE
SLURRY
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Tl.
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t r:ttNiSMDEVRL IIACtt'ti applicable;
FROM
TO
15.0IL 27.0 rt.
MATERIAL
20-40
EMPLACEMENT METHOD
FINE SILICA SAND
IL
ft,
trDRITX11.40 .Oltrurh ■rldi[wvul sheers'ifdAoessary).
FROM
0.0 IL
To
1.0 rt.
DESCRIPTION jrolar. hardness, rail/rock Irye, pain sign, erg.]
ASPHALT/GRAVEL
1.0 r'-
27.0 ft
BROWN/RED SANDY SILT
O.
ft.
ft.
ft,
rt.
fr.
f1.
rt.
re.
r.
Zi P KrMtiti•
BENTONITE SEAL FROM 13.0 TO 15.0 FEET
22. Certification:
Sigr[swaz ofCartifIed Well Co, 1mctw
10/24/13
Date
9y signing Ibis firm. 1 hereby «rljy filar the 11411(1) MT (Wee) cornirurxed ire vecarYlancc
rvi[!r ISA NCAC 02C.0100 or ISAI NCAC 02C .0200 Writ Cw,slnrplari Seondunk and rliu[ n
copj attar Falcon:Iurboor prvrrl+led to rho Well nhrner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCTIONS
24a. For All Wells: Submit thin folio within 30 days of completion of well
construction to the following:
Division of Water Quality, information Processing unit,
1617 Nish Service Center, Raleigh, NC 27699-1617
24b. For Infection Wells: in addition to sending the form to the address in 24a
above, also submit. a copy of this form within 30 days of completion of well
construction to the following:
Division of Water Quality, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC27699-1636
24c. For Water Simply & infection Wells: In addition to sending the four[ to
the address(es) above, also submit one copy of this form within 30 days of
completion of well construction to the county health department of the county
where constructed.
Form GW-I
Non!' Carotin 17npnrtment orEli virarrnrcntand Natural Resources- Division of Water Quality Rcviscd Jan, 2013