WI0400402_DEEMED FILES_20150730

Permit Number WI0400402
Program Category
Deemed Ground Water
Permit Type
Injection Deemed Other Well
Primary Reviewer
ebonee.shire
Coastal SWRule
Permitted Flow
Facility
Facility Name
Rotork/Fairchild Industrial Products Co. Facility
Location Address
3920 Westpoint Blvd
Winston Salem NC
Owner
Owner Name
Ares Capital Corporation
Dates/Events
Orig Issue
7/30/2015
App Received
6/10/2015
Re gulated Activities
Groundwater monitoring
Groundwater remediation
Outfall
Waterbody Name
27103
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
8/17/2015
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Perm it Contact Affiliation
Major/Minor
Minor
Region
Winston-Salem
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Joshua Bloomstein
& Counsel Gen'I Pres Vice
County
Forsyth
2200 Pennsylvania Ave Nw Ste 600-W
Washington DC 20037
Issue
7/30/2015
Effective
7/30/2015
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
r.-...i f.r: t 9 0d'J O —
Rogers, Michael
From: Shire, Ebonee
Sent: Friday, July 31, 2015 11:06 AM
To: Palmer, Gwendolyn M
Cc: Rogers. Michael
Subject: FW_ Fairchild Industrial Products NONCD0001700 - Preconstruction Report - Passive
Hydrogen
Attachments: AresPreconHydlnj pdf
From: Christopher Hay, EI, RSM [mailta:christonh-erh envirotrac.ccm]
Sent: Tuesday, June 09, 2015 9:02 AM
To: Shire, Ebonee
Subject: FW: Fairchild Industrial Products NONCD0001700 - Preconstruction Report - Passive Hydrogen
From: Christopher Hay, EI, RSM
Sent: Tuesday, June 09, 2015 8:56 AM
To; '[e-mail]'
Subject: FW: Fairchild Industrial Products NONCD0001700 - Preconstruction Report - Passive Hydrogen
Mr. Rogers,
Please find attached a Preconstruction Report and appended UIC Notification detailing the addition of a passive
hydrogen injection system to existing monitoring well UW-16 to aid in the groundwater remediation at the referenced
site. Please let me know if you have any questions or require additional information.
From: Christopher Hay, EI, RSM
Sent: Thursday, June 04, 2015 4:00 PM
To: Aufman, Matt
Subject: Fairchild Industrial Products NONCD0001700 - Preconstruction Report - Passive Hydrogen
Matt,
Please find attached a Preconstruction Report detailing the addition of a passive hydrogen injection system to existing
monitoring well DW-16 to aid in the groundwater remediation at the referenced site.
Christopher Hay, El, RSM l Regional Operations Manager J EnviroTrac Ltd. 17343 West Friendly Ave Suite J, Greensboro NC 27410
336.763.6025 (Office) i 336.763.6034 (Fax) l 336.602.0977 (Celli l christo: herh :envirotrac.corn
Solutions in Action - httr://www.envirotrac.com
CONFIOENTIAtITY_ This e-mail (including any attachments) may contain confidential, proprietary and privileged information, and unauthorized
disclosure or use is prohibited. If you received this e-mail in error, please notify the sender and delete this e-mail from your system.
f

....
PRECO NSTRUCTIO N REPORT -
(Addition of Passive Hydrogen
Injection System in DW-16)
Site:
ROTORK, FORMERLY FAIRCHILD INDUSTRIAL PRODUCTS COMPANY
3920 WESTPOINT BOULEVARD
WINSTON-SALEM, NORTH CAROLINA
SITE ID NO. NONCD0001700
Submitted To:
MR. MATTHEW AUFMAN
NCDENR -DIVISION OF WASTE MANAGEMENT
INACTIVE HAZARDOUS SITES BRANCH -REC PROGRAM
217 WEST JONES STREET
RALEIGH, NORTH CAROLINA 27603
Prepared By:
ENVIROTRAC LTD
7343 WEST FRIENDLY AVENUE, SUITE J
GREENSBORO, NC 27410
[phone]
MAY 2015
A Full Service Environmental Consulting
and Contracting Firm
Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0400402
Injection Deemed Other Well
Primary Reviewer
ebonee .shire
Coastal SWRule
Permitted Flow
Facility
Facility Name
Rotork/ Fairchild Industrial Injection Well
Location Address
3920 Westpoint Blvd
Winston Salem NC
Owner
Owner Name
Ares Capital Corporation
Dates/Events
Orig Issue
7/30/2015
App Received
6/10/2015
Regulated Activities
Groundwater monitoring
Outfall
Waterbody Name
27103
Draft Initiated
Scheduled
Issuance Publlc Notice
Central Files: APS SWP
7/30/2015
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Winston-Salem
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Joshua Bloomstein
& Counsel Gen'I Pres Vice
County
Forsyth
2200 Pennsylvania Ave Nw Ste 600-W
Washington DC 20037
Issue
7/30/2015
Effective
7/30/2015
Expiration
Requested /Received Ev_i,mts
Streamlndex Number Current Class Subbasln
Shire, Ebonee
From:
Sent:
To:
Cc:
Subject:
Attachments:
Shire, Ebonee
Thursday, June 11, 2015 11:17 AM
'[e-mail]'
Basinger, Corey; Knight, Sherri
Submittal Letter for Notice of Intent Form(NOI) for Rotork/ Fairchild Industrial Injection
Well WI0400402
Documentl.docx
1
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (NOi) at the
Rotork/ Fairchild Industrial Injection Well. This facility is located at 3920 Westpoint Blvd. 27103. We
received your complete NOi on June 10, 2015.
Please remember to submit the following regarding this injection activity:
1) Well Construction Records (GW-1) and Abandonment Records (GW-30) when completed. Please
provide copies of the GW-ls and GW-30s if not already submitted (originals go the address printed
on the form). NOTE: Direct push or Geoprobe wells are considered wells and require construction
(GW-1) and abandonment forms (GW-30). If well construction/abandonment information is the
same for the wells, only one form needs to be completed-just indicate total number of injection
points in the Comments/Remarks section of form. These forms can be found on our website at
http:ijportal.ncdenr.org/web/wq/aps/gwpro/reporting-forms.
2) Injection Event Records (IER). All injections, including air and passive systems require an IER. The
IER can be modified for air sparge wells (e.g., air flow 'continuous' for date or rate of injection, etc.).
You can scan and send these forms directly to me at michael.rogers @n~denr. ov send by fax to my
attention at 919-807-6406, or via regular mail to address below. When submitting the above forms, you
will need to enter the nine-digit alpha-numeric number on the form (i.e., WIOXXXXXX) that has been
assigned to the injection activity at this site. This notification has been given the deemed permit
number WI0400402 . This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in re p ly to this email, as it will already have the assigned
deemed permit number in the subject line.
Thank you for your cooperation.
Michael Rogers, P.G. (NC & FL)
Hyd rogeologist
NCDENR-DWR
Water Quality Regional Operations Section
1636 Mail Service Center
Raleigh, NC 27699
Direct No. 919-807-6406
Palmer, Gwendol y n M
From: Shire, Ebonee
Sent:
To:
Friday, July 31, 201511:06 AM
Palmer, Gwendolyn M
Cc: Rogers, Michael
Subject: FW: Fairchild Industrial Products NONCD000l 700 -Preconstruction Report -Passive
Hydrogen
Attachments: AresPrecon Hydlnj.pdf
From: Christopher Hay, El, RSM [mailto:christopherh @envirotrac.com]
Sent: Tuesday, June 09, 2015 9:02 AM
To: Shire, Ebonee
Subject: FW: Fairchild Industrial Products NONCD0001700 -Preconstruction Report -Passive Hydrogen
From: Christopher Hay, EI, RSM
Sent: Tuesday, June 09, 2015 8:56 AM
To: '[e-mail]'
Subject: FW: Fairchild Industrial Products NONCD0001700 -Preconstruction Report -Passive Hydrogen
Mr. Rogers,
Please find attached a Preconstruction Re·port and appended UIC Notification detailing the addition of a passive
hydrogen injection system to existing monitoring well DW-16 to aid in the groundwater remediation at the referenced
site. Please let me know if you have any questions or require additional information.
From: Christopher Hay, EI, RSM
Sent: Thursday, June 04, 2015 4:00 PM
To: Aufman, Matt
Subject: Fairchild Industrial Products NONCD0001700 -Preconstruction Report -Passive Hydrogen
Matt,
Please find attached a Preconstruction Report detailing the addition of a passive hydrogen injection system to existing
monitoring well DW-16 to aid in the groundwater remediation at the referenced site.
Christopher Hay, El, RSM I Regional Operations Manager I EnviroTrac Ltd. I 7343 West Friendly Ave Suite J, Greensboro NC 27410
336.763.6025 (Office) I 336.763.6034 (Fax) I 336.602.0977 (Cell) I [e-mail]
Solutions in Action -http ://www.envirotrac.com
1
CONFIDENTIALITY: This e-mail (including any attachments) may contain confidential, proprietary and privileged information, and unauthorized
disclosure or use is prohibited. If you received this e-mail in error, please notify the sender and delete this e-mail from your system.
2
EnvTri--o_i_ri_a_c
May 13, 2015
Mr. Mike Rogers
Division of Water Resources
1611 Mail Servi.ca Center
Erwironmental Services
.Raleigh, North Carolina 27699-1611
Reference: Notification of Intent to Construct or Operate Injection Wells
Rotork / Fairchild Industrial Products Company
3920 Westpoint Boulevard
Winston-Salem, North Carolina
Site ID No. NONCD0001700
Dear Mr. Rogers:
EnviroTrac is pleased to submit the enclosed Notification of Intent to Install or Construct Injection
Wells. The purpose of this enhancement to the current remediation_ regime is to target the
localized area of elevated tetrachloroethene concentrations in monitoring well DW-16 at the site.
Installing a passive hydrogen injection device in the well would increase the degradation rate of
chlorinated hydrocarbons but still allow the well to be used as a monitoring point.
Should you have any questions regarding this notification or require additional information, please
contact the undersigned. ·
Very truly yours,
ENVIROTRAC LTD.
~-~
I ,
Christopher-W. Hay, El, RSM
Principal
336.763.6025, Ext. 301
christorpherh @ envirotrac.com
Attachments: Notification of Intent to Install or Construct Injection Wells
Cc: Mr. Philip LeRoy, Ares Management
Mr. Matt Aufman, NCDENR REC Program
7343 West Friendly Avenue, Suite J, Greensboro, North Carolina 27410 I Office: [phone] I Fax: [phone]
www.envirotrac.com
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
NOTIFICATION OF INTENT 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 lSA NCAC 02C .0200. This form shall be submitted at least 2 weeks prior to injection.
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 O 5A NCAC 02C .0229):
1) Passive Injection Sv stems -In-well delivery systems to.diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale Injection O p erations -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: May 11. 2015 PERMIT NO. W lOYOOt.102.· (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(1)
(2)
(3)
(4)
(5)
(6)
___ Air Iajection Well ...................................... Complete sections B-F, K, N
___ Aquifer Test Well ....................................... Complete sections B-F, K, N
~X~ __ Passive Injection System ............................... Complete sections B-F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B-N
___ Pilot Test. ................................................ Complete sections B-N
___ Tracer Injection Well ................................... Complete sections B-N
B. STATUS OF WELL OWNER: Business/Organization
C. WELL OWNER -State name of entity and name of person delegated authority to sign on behalf of the
business or agency:
Name: Mr. Joshua Bloomstein -Ares Capital Corp oration
Mailing Address: 2200 Penns lvania Avenue NW . Suite 600-W
City: W ashirnrt on State: _D_C~_Zip Code: 20037 County:~D_C~----
Day Tele No.: (202 )721-6146 Cell No.: -----------
EMAIL Address: ---------------Fax No.: ___________ _
UIC//n Situ Remed. Notification (Revised 8/5/2013) Page 1
D. PROPERTY OWNER (if different than well owner)
Name: Fawn Industrial. LLC
c/o CB Richard Ellis of VA as Agent Attn: Lori Starnes
Mailing Address: ___ -=-10=1=---=C=e=nt=e=rp=o=rt-'-D==ri'-'-v"""e""'. S"""u=i=te~l 6""'0"-------------------
City: Greensboro State: NC Zip Code:_2_7~4~0~9 ____ County:_G_ui_I-fi_o_rd _____ _
Day Tele No.: [phone] Cell No.: __________ _
EMAIL Address: lori.stames(w,cbre.com Fax No.: ___________ _
E. PROJECT CONT ACT -Person who can answer technical questions about the proposed inje"ttion project.
Name: Chris Hav -EnviroTrac. Ltd
Mailing Address: ___ 7_3_4_3_W_es_t_F_r_ie_n_d~lv_A_ve~S_u_it_e_J __________________ _
City: Greensboro State: NC_ Zip Code:=2-'--74-'--'l'"""0 ____ County: Guilford
Day Tele No.: [phone] Cell No.: [phone]
EMA IL Address: christopherh (a envirotrac.com Fax No.: ___________ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Physical Address: 3920 Westpoint Boulevard (Figure 1)
County: Fors vth
(2)
City: Winston-Salem State: NC Zip Code: ~2~7-=-10~3~------
Geographic Coordinates: Latitude**: _0
__ __" or ~3~6_0 --=-03""'8""'0'""'7-"5 ______ _
Longitude**: _0
_· _-_' __ "or -80 ° --=-3=25~7~5~6~------
Reference Datum: ________ Accuracy: _______ _
Method of Collection: http://itouchmap.com/latlong.html
**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: _______ square feet
Land surface area ofinj. well network: square feet (::S 10,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: (must be ::S 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
Figure 3 shows the site layout, existing monitoring wells, and HRC injection locations. Figure 6
shows the extent of impacted groundwater. The passive hydrogen injection system is proposed
to be installed into DW-16.
VIC/In Situ Remed. Notification (Revised 8/5/2013) Page2
(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.
Figure 7 shows the location of the cross sections. Figures 8, 9, and 10 are cross sections of impacted
groundwater. The figures estimate the extent of tetrachloroethene concentrations which exceed
the NCGS 2L Standard. Figure 11 shows the potentiometric surface map.
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity.
The in jection activities are intended to improve groundwater concentrations. Tetrachloroethene concentrations
across the site are decreasing with the exce ption of monitorirnr well DW-16. Monitorin!! well DW-16 will have
a passive h vdro gen delive rv s ystem installed inside the monitoring_ well. This s stem will allow h vdro gen to be
in jected into the ex oundwater affecting a localized area. The performance of this s ystem will be monitored
during the current semi-annual monitoring events.
J. INJECTANTS -Provide a MSDS and the following for each injectant. Attach additional sheets if necessary.
NOTE: Approved injectants (tracers and remediation additives) can be found online at
http://portal.ncdenr.org/web/wq/aps/gwpro. All other substances must be reviewed by the Division of Public
Health, Department of Health and Human Services. Contact the UIC Program for more info (919-807-6496).
Injectant: H ydro gen -MSDS attached
Volume of injectant: continuous release of h ydro gen £?.as at one cubic foot per day
Concentration at point of injection: DW-16 will rang e from 2.2 to 2.4 ppm (based on 13 _to 17 feet of
submere ence ). The hy dro gen concentrations are estimated based on a saturated h vdro gen content of
1.6 ppm per atmos phere.
Percent ifin a mixture with other injectants: NA
Injectant:
Volume ofinjectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: __ Proposed _1_ Existing =D----'W-'------'1'"""6'----------------
(2) 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:
(a) well type as permanent, direct-push, or subsurface distribution system (infiltration gallery)
(b) depth below land surface of grout, screen, and casing intervals
( c) well contractor name and certification number
UIC!In Situ Remed. Notification (Revised 8/5/2013) Page 3
Well installation sketches and well construction records for DW-16 are attached.
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Envirotrac will travel to the site and install the delivery system prior to the September 20!5 sampling evens.
The hydrogen will be injected cocain sushi, and =lie content of the hydrogen cylinders and Field parameters will
be monitored monthly.
141. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations ofgrnundwater quality standards specified in Sub:.hauter U^L result from the injection activity.
Groundwater samples will be collected from DW-16 semi-annually concurrent with the ongoing monitoring
schedule. The Performance of tie nassivebvdrogen delivery system will be evaluated following 6 months of
operation.
N. CERTIFICATION Ito be ++Figni d as required below or by that person's authorized agent)
1 SA NCAC_Q2C:.02111c) requires that all permit applications shall be signed as follows:
I. for a corporation: by a responsible corporate officer;
2, for a partnership or sole proprietorship: by a general partner or the proprietor, respectively:
3. for a municipality or a state, federal, or other public agency: by either a principal executive officer or
ranking publicly elected official;
4. for ail others: by the we]1 owner;
5. for any other person authorized to act on behalf of the applicant; documentation shall be suhntitied
with the notification that clearly identifies the person, grants them signature authority. and is signed
and dated by the applicant.
'I hereby certih,, under peualy of law, that 1 have personally examined and acre familiar with the information
submitted in thisdocument and all attachments thereto and than, based on my inquiry of those individuals
immediately responsible jar obtaining said information, I believe that the information is true, accurate and
complete. 1 am aware that there are signs f scout penalties, including the possibility of f fines and imprisonment,
for suhn+itt'ng false injarrnation. I agree to construct, operate maintain, repair, and if applicable, abandon
the injection well and all related appurtenances in accordance ce with the .1.55,4 NCAC 02C 0 00 Rules."
'`1 iir-1 triwr��s i
r l4drta a of Applicaan`tt Printer Type Pull Name c,O4a-6' -
Steriu9tre of Property +?• net ([f different scow applicrtrr!) Print or Type F ame
Signature of Authorized Agent, if Any
Submit one copy of the completed notification package to:
DWR - Aquifer Protection Section
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone] j Fax_ (914) 8074496
Lli[ �fn Sim Remed. Nutiticatson (Revised Sol/2013)
Print or Type Puit Name
Part =i

NORnt CAROLINAO£PMTMENTO, l!NVIRONMENr NflJ NATIIIW. IU$OURCU
DM8ION OFll!NVltONMENTALIWWmlElff •CIIIOUN&JWATMla;TION
P.O. BOX27117 •RALEIGH, N.C. 211'1•7187, PHCIME (111) '1N22t
fOR OfFIC£ use ONLY
Quad. No. ____ Ser111No. ___ _
weu CONSTRUCTION RECORD
DRIWNGI CONTRACTOR wto!klft YddWJI
DRILL.Ill RH18'1RA-,,. NUIIBIR 2071
1. WEU. LOCA'TION: (Sllaw lketCh of the loc:allon below)
Nallllll Town: WJRIIM:iWD, Npdb Caroh
M W1111pGJr4 BDU1mna
(Rold, Communll1, or SUbdlvlllon and LOI No.)
2. O\tVNER falrdljld h]dylldel Pmduda
ADDR!Ss mow,,,.. e,unat
(Street or Ro"'8 No.)
Wlot1m:tiolwn, NQrlb QIIJb 271H
City or TOMI st• Zip Code
3. DATE DRILLED 1MG'QII USE OF WELL MQalqrlnq
4. TOTAL DEPnl 31,0 CUTTINGS COLLECTeD 181 VN O No
8. DOES WELL REf'llACE EXISTING WB.l? □ Yes 9 No
e. STATIC WATER LEVEL: 1tJI& FT.□ abCMITOPOFCASING,
1811191o#
TOP OF CASING IS Cl FT. ABOVE LAND SURFACE
7. VIEU> (1pm): NIA METHOD OFTEST ....... Nt .. ,t...._ ____ _
8. WATER ZONES (deptlt): _,..,.J:N"'ls'------------
t . CHLOMIATION: ~.JIIA_Amount NIA
1.1,.._ ___ 1.ong. ___ Po ___ _
WnorBll~-----------
BaenCada ----"""':~~~--,.--HNcier Bit. OW-1 Ent.
ITATB Wl!U.COMTRUCTION
PIIUIT NUIINII: NA
Coun(y:,_......s.facmth!SII'--
DW-18
'1111111 DRIWNGLQB .
FRlffl To Fcrma11an DNotpllon
See Bprtng Low DW:10
If~ apace II needed, ... baek orronn.
10. CASING: WalTlllclulMa Mateltll bOCAJJQN SKETCH
Depl'I Dlametar arWllghtlfl
FfOffl ....,L_To.aJlF'I, 2" §cbldula ◄P
Fram_ To.....Jt.
From_ To ___Ft.
1-t. GROUT:
Depth Mlfeflll
From _JL_ToatJLFL .i;edi.¥1~1Urp.,,_ ____ _
From_To_Ft.
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Depll,
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FrorA_ To _ft.
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13. GRAVB. PACK:
Depth
From_w_ToJIJL,Ft.
From_ To__Jt.
Dramater
z:
Size
11111:rm
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n. · l!Jtl!l'.
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14. REMARKS: Bwllpnfte 1120:P 1P 2A P mt btfoW ground tyrfacp
[si-Cllnlcllmlnlllll.-itanltlNlttw.._lbD.arllllllt11111plntlllllpoiNI)
SeeOrawirVNo.1
I DO HEREBY CERTIFY TiiAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WJTH 11 NCAC IC, WEll CONS'TRUCTION STANDARDS,
ANDTHATACOPYOfl1t8 RECORD HAS BEEN PROVIDED TO THE WELL OWN~~
SIGNATUR! OF CONTRACTOR ORABQM
SUbrolt ollglnll lo Dlvfllan of Enwonmenlet Management 111'111 copy lO wall owner.
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REFERENCE NOTE:
VICINITY MAP CREATED FROM DATA COMPILED BY USGS QUAD MAP WINSTON-SALEM
WEST QUADRANGLE DATED 2013.
0 2000 4000 6000
MN UM
SCALE: 1" = 2000' SCALE IN FEET
EFrc
Environmental Services
7343 W. FRIENDLY AVENUE, SUITEJ
GREENSBORO, NORTH CAROLINA
PHONE: [phone]
PROJECT NO. 11.990015.00
DRAWN BY: AB
CHECKED BY: CWH
DATE: 3-20-15
REVISED:
SITE VICINITY MAP
(REGIONAL)
ROTORKJFAIRCHILD INDUSTRIAL PRODUCTS CO.
3920 WESTPOINT BOULEVARD
WINSTON-SALEM, NC
FIGURE
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LEGEND
FFE = FINISHED FLOOR ELEVATION
PCE = TETRACHLOROETHENE
TCE = TRICHLOROETHENE
TRANS-12-DCE = TRANS-1,2-DICHLOROETHENE
CIS-1,2-DCE = CIS-1,2-D!CHLOROETHENE
VC = VINYL CHLORIDE
BDL= BELOW DETECTION LIMITS
= GREATER THAN 2L STANDARDS
NOTES
CONCENTRATIONS BASED ON MARCH 2015 DATA: REPORTED IN
MICROGRAMS PER LITER.
BASED ON DRAWING FROM KLEINFELDER REMEDIAL INVESTIGATION
REPORT.
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TCE = TRICHLOROETHENE
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CIS-1,2-DCE = CIS-1,Z-DICHLOROETHENE
VC = VINYL CHLORIDE
Bit =BELOW DETECTION LIMITS
= GREATER THAN 2L STANDARDS
NOTES
CONCENTRATIONS BASED ON MARCH 2015 DATA; REPORTED IN
MICROGRAMS PER LITER.
BASED ON DRAWING FROM KLEINFELDER REMEDIAL INVESTIGATION
REPORT.
ENVIROTRAC - 7343 W. FRIENDLY AVE., SUITE J I GREENSBORO, NC 27410 I PH: [phone] I FAX: [phone] I www.envirotrac.com

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ENVIROTRAC - 7343 W. FRIENDLY AVE., SUITE J.I GREENSBORO, NC 27410 I PH: [phone] I FAX: [phone] I www,envirotrac.carn

HYDROGEN MSDS
SAFETY DATA SHEET
AIE!JS
Hydrogen
Section 1. Identification
GHS product identifier
Chemical name
Other means of
identification
Product use
Synonym
SOS #
Supplier's details
Emergency telephone
number (with hours of
operation)
Hydrogen
hydrogen
Dihydrogen: o-Hydrogen; p-Hydrogen;
: Synthetic/Analytical chemistry.
: bihydrogen, a -Hydrogen; p-Hydrogen;
: 001026
: Airgas USA, LLC and its affiliates
259 North Radnor -Chester Road
Suite 100
Radnor, PA 19087-5283
1-610-687-5253
: 1-866-734-3438
Molecular hydrogen: H2: UN 1049
Molecular hydrogen: H2; UN 1049
Section 2. Hazards identification
OSHAIHCS status
Classification of the
substance or mixture
al -IS label elements
Hazard pictograms
Signal word
Hazard statements
Precautionary statements
General
Prevention
Response
Storage
Disposal
This material is considered hazardous by the OSHA Hazard Communication Standard
(29 CFR 1910.1200).
: FLAMMABLE GASES - Category 1
GASES UNDER PRESSURE - Compressed gas
• Danger
. Extremely flammable gas.
Contains gas under pressure; may explode if heated.
Bums with invisible flame.
May displace oxygen and cause rapid suffocation.
: Read and follow all Safety Data Sheets (SDS'S before use. Read label before use.
Keep out of reach of children, If medical advice is needed, have product container or
label at hand. Close valve after each use and when empty. Use equipment rated for
cylinder pressure. Do not open valve until connected to equipment prepared for use.
Use a back flow preventative device in the piping. Use only equipment of compatible
materials of construction. Approach suspected leak area with caution,
Never Put cylinders into unventilated areas of passenger vehicles. Keep away from
heat, sparks, open flames and hot surfaces. - No smoking. Use and store only outdoors
or in a well ventilated place.
: Leaking gas fire: Do not extinguish, unless leak can be stopped safely. Eliminate all
ignition sources if safe to do so.
Protect from sunlight. Protect from sunlight when ambient temperature exceeds
52°C/125°F. Store in a well -ventilated place.
Not applicable.
Date ofissue/Date of revision : 10115/2014. Date of previous issue : 10/212014. Version : 0.02 1/12
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Hyarogen
I Section 2. Hazards identification
Hazards not otherwise
classified
: In addition to any other important health or physical hazards, this product may displace
. oxygen and cause rapid suffocation.
I section 3. Composition/information on ingredients
Substance
hydrogen
Substance/mixture
Chemical name
Other means of
identification
Dihydrogen; o-Hydrogen; p-Hydrogen; Molecular hydrogen; H2; UN 1049
CAS number/other identifiers
CAS number 1333-74-0
Product code 001026
Ingredient name % CAS number
hydrogen 100 1333-74-0
There are no additional ingredients present which, within the current knowledge of the supplier and in the
concentrations applicable, are classified as hazardous to health or the environment and hence require reporting
in this section.
Occupational exposure limits, if available, are listed in Section 8.
j section 4. First aid measures
Descrj ptjon of necessa ry first aid measures
Eye contact
Inhalation
Slcin contact
Ingestion
Immediately flush eyes with plenty of water, occasionally lifting the upper and lower
eyelids. Check for and remove any contact lenses. Continue to rinse for at least 10
minutes. Get medical attention if irritation occurs.
Remove victim to fresh air and keep at rest in a position comfortable for breathing . If
not breathing, if breathing is irregular or if respiratory arrest occurs, provide artificial
respiration or oxygen by trained personnel. It may be dangerous to the person providing
aid to give mouth-to-mouth resuscitation. Get medical attention if adverse health effects
persist or are severe. If unconscious, place in recovery position and get medical
attention immediately. Maintain an open airway. Loosen tight clothing such as a collar,
tie, belt or waistband.
Flush contaminated skin with plenty of water. Remove contaminated clothing and
shoes. To avoid the risk of static discharges and gas ignition, soak contaminated
clothing thoroughly with water before ren:,oving it. Get medical attention if symptoms
occur. Wash clothing before reuse . Clean shoes thoroughly before reuse.
As this product is a gas, refer to the inhalation section.
Most im portant sym ptoms/effects . acute and delayed
Potential acute health effects
Eye contact
Inhalation
Skin contact
Frostbite
Ingestion
Contact with rapidly expanding gas may cause burns or frostbite.
No known significant effects or critical hazards.
Contact with rapidly expanding gas may cause bums or frostbite.
Try to warm up the frozen tissues and seek medical attention.
As this product is a gas, refer to the inhalation section .
Over-exposure signs/sy mptoms
Eye contact
Inhalation
Skin contact
Date of issue/Date of revision
No specific data.
No specific data.
No specific data.
: 10/1512014. Date of previous issue : 10/212014 . Version : 0. 02
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Hyarogen
I Section 4. First aid measures
Ingestion : No specific data.
Indication of immediate medical attention and s pecial treatment needed . if necessary
Notes to physician Treat symptomatically. Contact poison treatment specialist immediately if large
quantities have been ingested or inhaled.
Specific treatments
Protection of first-aiders
No specific treatment.
No action shall be taken involving any personal risk or without suitable training. It may
be dangerous to the person providing aid to give mouth-to-mouth resuscitation.
See toxicological information (Section 11)
[ S~ction 5. Fire-fighting measures
Extin g uishin g media
Suitable extinguishing
media
Unsuitable extinguishing
media
Specific hazards arising
from the chemical
Hazardous thermal
decomposition products
Special protective actions
for fire-fighters
Use an extinguishing agent suitable for the surrounding fire.
None known.
Contains gas under pressure. Extremely flammable gas. In a fire or if heated, a
pressure increase will occur and the container may burst, with the risk of a subsequent
explosion.
No specific data.
Promptly isolate the scene by removing all persons from the vicinity of the incident if
there is a fire. No action shall be taken involving any personal risk or without suitable
training. Contact supplier immediately for specialist advice. Move containers from fire
area if this can be done without risk. Use water spray to keep fire-exposed containers
cool. If involved in fire, shut off flow immediately if it can be done without risk. If this is
impossible, withdraw from area and allow fire to burn. Fight fire from protected location
or maximum possible distance. Eliminate all ignition sources if safe to do so.
Special protective Fire-fighters should wear appropriate protective equipment and self-contained breathing
equipment for fire-fighters apparatus (SCBA) with a full face-piece operated in positive pressure mode.
I Section 6. Accidental release measures
Personal p recautions , protective eq ui pment and emergency procedures
For non-emergency Accidental releases pose a serious fire or explosion hazard. No action shall be taken
personnel involving any personal risk or without suitable training. Evacuate surrounding areas.
Keep unnecessary and unprotected personnel from entering. Shut off all ignition
sources. No flares, smoking or flames in hazard area. Avoid breathing gas. Provide
adequate ventilation. Wear appropriate respirator when ventilation is inadequate. Put
on appropriate personal protective equipment.
For emergency responders If specialised clothing is required to deal with the spillage, take note of any inforr:nation
in Section 8 on suitable and unsuitable materials. See also the information in "For non-
emergency personnel".
Environmental precautions Ensure emergency procedures to deal with accidental gas releases are in place to avoid
contamination of the environment. Inform the relevant authorities ifthe,product has
caused environmental pollution (sewers, waterways, soil or air).
Methods and materials for containment and cleanin g up
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/212014. Version : 0. 02 3/12
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Section 6. Accidental release measures
Small spill Immediately contact emergency personnel. Stop leak if without risk. Use spark-proof
tools and explosion-proof equipment.
Large spill Immediately contact emergency personnel. Stop leak if without risk. Use spark-proof
tools and explosion-proof equipment. Note: see Section 1 for emergency contact
information and Section 13 for waste disposal.
I Section 7. Handling and storage
Precautions for safe handlin g
Protective measures
Advice on genera l
occupational hygiene
Conditions for safe storage,
including any
incompatibilities
Put on appropriate personal protective equipment (see Section 8). Contains gas under
pressure. Avoid contact with eyes, skin and clothing. Avoid breathing gas. Use only
with adequate ventilation. Wear appropriate respirator when ventilation is inadequate.
Do not enter storage ar~as and confined spaces unless adequately ventilated. Ster~
and u~e away from heat, sparks, open flame or any other ignition s9urce. Use
explosion-proof electrical (ventilating, lighting and material handling) equipment. Use
only non-sparking tools. Empty containers retain product residue and can be hazardous.
Do not puncture or incinerate container. Use equipment rated for cylinder pressure.
Close valve after each use and when empty. Protect cylinders from physical damage;
do not drag, roll, slide, or drop. Use a suitable hand truck for cylinder movement.
Eating, drinking and smoking should be prohibited in areas where this material is
handled, stored and processed . Workers should wash hands and face before eating,
drinking and smoking. Remove contaminated clothing and protective equipment before
entering eating areas. See also Section 8 for additional information on hygiene
measures.
Store in accordance with local regulations. Store in a segregated and approved area .
Store away from direct sunlight in a dry, cool and well-ventilated area, away from
incompatible materials (see Section 10). Eliminate all ignition sources. Keep container
tightly closed and sealed until ready for use. Cylinders should be stored upright, with
valve protection cap in place, and firmly secured to prevent falling or being knocked
over. Cylinder temperatures should not exceed 52_ °C (125 °F).
I Section 8. Exposure controls/personal protection
Control parameters
Occuoational ex posure limits
Ingredient name
hydrogen
Appropriate engineering
controls
Environmental exposure
controls
Individual protection measures
Date of issue/Date of revision
Exposure limits
Oxygen Depletion [Asphyxiant]
Use only with adequate ventilation. Use process enclosures, local exhaust ventilation or
other engineering controls to keep worker exposure to airborne contaminants below any
recommended or statutory limits. The engineering controls also need to keep gas,
vapor or dust concentrations below any lower explosive limits. Use explosion-proof
ventilation equipment.
Emissions from ventilation or work process equipment should be checked to ensure
they comply with the requirements of environmental protection legislation. In some
cases, fume scrubbers, filters or engineering modifications to the process equipment
will be necessary to reduce emissions to acceptable levels.
: 10/1512014. Date of previous issue : 1012/2014. Version : 0. 02
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Hyarogen
I Section 8. Exposure controls/perso.nal protection
Hygiene measures
Eye/face protection
Skin p rotection
Hand protection
Body protection
Wash hands, forearms and face thoroughly after handling chemical products, before
eating, smoking and using the lavatory and at the end of the working period.
Appropriate techniques should be used to remove potentially contaminated clothing.
Wash contaminated clothing before reusing. Ensure that eyewash stations and safety
showers are close to the workstation location.
Safety eyewear complying with an approved standard should be used when a risk
assessment indicates this is necessary to avoid exposure to liquid splashes, mists,
gases or dusts. If contact is possible, the following protection should be worn, unless
the assessment indicates a higher degree of protection: safety glasses with side-
shields.
Chemical-resistant, impervious gloves complying with an approved standard should be
Worn at all times when handling chemical products if a risk assessment indicates this is
necessary. Considering the parameters specified by the glove manufacturer, check
during use that the gloves are still retaining their protective properties. It should be
noted that the time to breakthrough for any glove material may be different for different
glove manufacturers. In the case of mixtures, consisting of several substances, the
protection time of the gloves cannot be accurately estimated.
Personal protective equipment for the body should be selected based on the task being
performed and the risks involved and should be approved by a specialist before
handling this product. When there is a risk of ignition from static electricity, wear anti-
static protective clothing, For the greatest protection from static discharges, clothing
should include anti-static overalls, boots and gloves.
Other skin protection Appropriate footwear and any additional skin protection measures should be selected
based on the task being performed and the risks involved and should be approved by a
specialist before handling this product.
Respiratory protection Use a properly fitted, air-purifying or air-fed respirator complying with an approved
standard if a risk assessment indicates this is necessary. Respirator selection must be
based on known or anticipated exposure levels, the hazards of the product and the safe
working limits of the selected respirator.
I Section 9. Physical and chemical properties -I
Appearance
Physical state
Color
Molecular weight
Molecular formula
Boiling/condensation point
Melting/freezing point
Critical temperature
Odor
Odor threshold
pH
Fl_ash point
Burning time
Burning rate
Evaporation rate
Flammability (solid, gas)
Lower and upper explosive
(flammable) limits
Date of issue/Date of revision
Gas
Colorless.
2.02 g/mole
H2
-253°C (-423.4°F)
-259.15°C (-434SF)
-240.15°C (-400.3°F)
Odorless.
Not available.
Not available.
Not available.
Not applicable.
Not applicable.
Not available.
Extremely flammable in the presence of the following materials or conditions: oxidizing
materials.
Lower: 4%
Upper: 76%
: 10/15/2014. Date of previous issue : 10/2/2014. Version : o. 02 5112
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Hyarogen
I Section 9. Physical and chemical properties
Vapor pressure
Vapor density
Specific Volume (ft 3/lb)
Gas Density {lb/ft 3)
Relative density
Solubility
Solubility in water
Partition coefficient: n-
octanol/water
Auto-ignition temperature
Not available.
0.07 (Air= 1)
191.9386
0.00521
Not applicable.
Not available.
Not available.
Not available.
Liquid Density@BP: 4.43 lb/ft3 (70.96 kg/m3)
500 to 571 °C (932 to 1059.8°F)
Decompositi'on temperature Not available.
SADT Not available.
Viscosity Not applicable.
I Section 10. Stability and reactivity
Reactivity
Chemical stability
Possibility of hazardous
reactions
-Conditions to avoid
Incompatibility with various
substances
No specific test data related to reactivity available for this product or its ingredients.
The product is stable.
Under normal conditions of storage and use, hazardous reactions will not occur.
Avoid all possible sources of ignition (spark or flame). Do not pressurize, cut, weld,
braze, solder, drill, grind or expose containers to heat or sources of ignition.
Extremely reactive or incompatible with the following materials: oxidizing materials.
Hazardous decomposition
products
Under normal conditions of storage and use, hazardous decomposition products should
not be produced.
Hazardous polymerization : Under normal conditions of storage and use, hazardous polymerization will not occur.
Section 11. Toxicological information
Inform ation on toxicolo gical effects
Acute toxici ty
Not available.
Irritation/Corrosion
Not available.
Sensitization
Not available.
Mutag enicity
Not available.
Ca rcinogenicity
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/212014. Version : 0. 02
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Hyarogen
I Section 11. Toxicological information
Not available.
Re p roductive toxicity
Not available.
Terato qenicity
Not available.
Specific targ et organ toxicity (sin g le exposure )
Not available.
Specific tar get organ toxicity (re peated ex posure )
Not available.
Aspiration hazard
Not available.
Information on the likely Not available.
routes of exposure
Potential acute health effects
Eye contact Contact with rapidly expanding gas may cause burns or frostbite.
Inhalation No known significant effects or critical hazards.
Skin contact Contact with rapidly expanding gas may cause burns or frostbite.
Ingestion As this product is a gas, refer to the inhalation section.
Symptoms related to the physical, chemical and toxicological characteristics
Eye contact No specific data.
Inhalation
Skin contact
Ingestion
No specific data.
No specific data.
No specific data.
Dela yed and immediate effects and also chronic effects from short and lon g term ex posure
Short term exposure
Potential immediate
effects
Potential delayed effects
Long term exposure
Potential immediate
effects
Potential delayed effects
Potential chronic health effects
Not available.
General
Carcinogenicity
Mutagenicity
Teratogenicity
Developmental effects
Fertility effects
Not available.
Not available.
Not available.
Not available.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
No known significant effects or critical hazards.
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/212014. Version : 0. 02
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Nyarogen
Section 11. Toxicological information
Numerical measures of toxicity
Acute toxici ty estimates
Not available.
I Section 12. Ecological information
Toxicity
Not available.
Persistence and deg radabiii ty
Not available.
Bioaccumulative potentiai
Not available.
MobUitv in soil
Soil/water partition
coefficient (Koc)
Not available.
Other adverse effects : No known significant effects or critical hazards.
I Section 13. Disposal considerations
Disposai methods The generation of waste should be avoided or minimized wherever possible. Disposal
of this product, solutions and any by-products should at all times comply with the
requirements of environmental protection and waste disposal legislation and any -
regional local authority requirements. Dispose of surplus and non-recyclable products
via a licensed waste disposal contractor. Waste shoula not be disposed of untreated to
the sewer unless fully compliant with the requirements of all authorities with jurisdiction.
Empty Airgas-owned pre_ssure vessels should be returned to Airgas. Waste packaging
should be recycled. Incineration or landfill should only be considered when recycling is
not feasible. This material and its container must be disposed of in a safe way. Empty
containers or liners may retain some product residues. Do not puncture or incinerate
container.
I Section 14. Transport information
DOT TDG Mexico IMDG IATA
UN number UN1049 UN1049 UN1049 UN1049 UN1049
UN proper HYDROGEN, HYDROGEN, HYDROGEN HYDROGEN, HYDROGEN,
shipping name COMPRESSED COMPRESSED COMPRESSED COMPRESSED COMPRESSED
Transport 2.1 2.1 2.1 2.1 2.1
hazard class(es) ♦ ♦ ♦ ♦ ♦
Packing group -----
Environment No. No. No. No. No.
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 10/212014. Version : 0. 02 8112
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nyarogen
Section 14. Transport information
Additional bimited guanti~ ~2U!l2iilt'.!\l Limit s!Dd --Passenger 51nd Ci!rgQ
Yes. Limited Quanti~ lnd!;lX ~Quantity information 0.125 limitation: 0 Forbidden
Packa gin g in st ruction Cs![QQ Aircri!ft Qnll,!
Passenger aircraft ERAP In dex Quantity limitation: 150
Quantity limitation: 3000 kg
Forbidden.
Passenger Car[lling
Cargo aircraft Shi p Index
Quantity limitation: 150 Forbidden
kg
Passenger Car[lling
Bos1d Qr Ri!il lad!\ll!
Forbidden
"Refer_ to CFR 49 (or authority having jurisdiction) to determine_ the information required for shipment of the
product."
Special precautions for user Transport within user's premises: always transport in closed containers that are
upright and secure. ~nsure that persons transporting the product know what to do in the
event of an accident or spillage.
Transport in bulk according
to Annex II of MARPOL
73/78 and the iBC Code
Not available.
!section 15. Regulatory information
U.S. Federal regulations
Clean Air Act Section 112
(b) Hazardous Air
Pollutants (HAPs)
Clea_n Air Act Section 602
Class I Substances
Clean Air Act Section 602
Class II Substances
DEA List I Chemicals
(Precursor Chemicals)
DEA List II Chemicals
(Essential Chemicals)
SARA 302/304
TSCA 8(a) CDR Exempt/Partial exemption: This material is listed or exempted.
United States inventory (TSCA 8b): This material is listed or exempted.
Clean Air Act (CAA) 112 regulated flammable substances: hydrogen
Not listed
Not listed
Not listed
Not listed
Not listed
Composition/information on ingredients
No products were found.
SARA304RQ
SARA 311/312
Classification
Not applicable.
: Fire hazard
Sudden release of pressure
Com p osition/information on in g redients
Date of issue/Date of revision : 10115/2014. Date of previous issue : 10/212014. Version : 0. 02
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rfyorogen
Section 15. Regulatory information
Name
%
Fire
hazard
Sudden
release of
pressure
Reactive
immediate
(acute)
health
hazard
Delayed
(chronic)
health
hazard
hydrogen
100
Yes.
Yes.
No.
No.
No.
State regulations
Massachusetts
New York
New Jersey
Pennsylvania
Canada inventory
International regulations
International lists
Chemical Weapons
Convention List Schedule
I Chemicals
Chemical Weapons
Convention List Schedule
II Chemicals
Chemical Weapons
Convention List Schedule
III Chemicals
Canadg,
WHMIS (Canada)
This material is listed.
This material is not listed.
This material is listed.
This material is listed.
This material is listed or exempted.
Australia inventory (AICS): This material is listed or exempted.
China inventory (IECSC): This material is listed or exempted.
Japan inventory: Not determined.
Korea inventory: This, material is listed or exempted.
Malaysia Inventory (EHS Register): This material is listed or exempted,
New Zealand Inventory of Chemicals (NZIoC): This material is listed or exempted.
Philippines inventory (PICCS): This material is listed or exempted.
Taiwan inventory (CSNN): Not determined.
Not listed
: Not listed
: Not listed
: Class A: Compressed gas.
Class B-1: Flammable gas.
CEPA Toxic substances: This material is not listed_
Canadian ARET: This material is not listed.
Canadian NPRI: This material is not listed.
Alberta Designated Substances: This material is not listed.
Ontario Designated Substances: This material is not listed.
Quebec Designated Substances: This material is not listed.
Section 16. Other information
Canada Label requirements Class A: Compressed gas.
Class B-1: Flammable gas.
Hazardous Material Information System tU.S.A.i
Flammability
Physical hazards
Version :0.02 10/12
Date of issuelDate of revision
10/1512014. Date of previous issue
: 1012/2014.
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hyarogen
Section 16. Other information
Caution: HM1S® ratings are based on a 0-4 rating scale, with 0 representing minimal hazards or risks, and 4
representing significant hazards or risks Although HMIS® ratings are not required on SDSs under 29 CFR 1910.
1200, the preparer may choose to provide them. HMIS® ratings are to be used with a fully implemented HMIS®
program. HMIS® is a registered mark of the National Paint & Coatings Association (NPCA). HMIS® materials
may be purchased exclusively from J. J. Keller [phone].
The customer is responsible for determining the PPE code for this material.
National Fire Protection Association ' U.S.A.
Flammability
Health 4 0 Instability/Reactivity
Special
Reprinted with permission from NFPA 704-2001, Identification of the Hazards of Materials for Emergency
Response Copyright ©1997, National Fire Protection Association, Quincy, MA 02269. This reprinted material is
not the complete and official position of the National Fire Protection Association, on the referenced subject
which is represented only by the standard in its entirety.
Copyright ©2001, National Fire Protection Association, Quincy, MA 02269. This warning system is intended to
be interpreted and applied only by properly trained individuals to identify fire, health and reactivity hazards of
chemicals. The user is referred to certain limited number of chemicals with recommended classifications in
NFPA 49 and NFPA 325, which would be used as a guideline only. Whether the chemicals are classified by NFPA
or not, anyone using the 704 systems to classify chemicals does so at their own risk.
History
Date of printing . 10/15/2014.
Date of issuelDate of 10/15/2014.
revision
Date of previous issue : 10/2/2014.
Version : 0.02
Key to abbreviations : ATE = Acute Toxicity Estimate
BCF = Bioconcentration Factor
GHS = Globally Harmonized System of Classification and Labelling of Chemicals
IATA = International Air Transport Association
IBC = Intermediate Bulk Container
IMDG = International Maritime Dangerous Goods
LogPow = logarithm of the octanollwater partition coefficient
MARPOL 73/78 = International Convention for the Prevention of Pollution From Ships,
1973 as modified by the Protocol of 1978. ('Marpol" = marine pollution)
UN = United NationsACGIH — American Conference of Governmental lndustrial
Hygienists
AIHA — American Industrial Hygiene Association
CAS — Chemical Abstract Services
CEPA — Canadian Environmental Protection Act
CERCLA -- Comprehensive Environmental Response, Compensation, and Liability Act
(EPA)
CFR — United States Code of Federal Regulations
CPR — Controlled Products Regulations
DSL — Domestic Substances List
GWP — Global Warming Potential
IARC — International Agency for Research on Cancer
ICAO — International Civil Aviation Organisation
Inh — Inhalation
LC — Lethal concentration
LD — Lethal dosage
NDSL — Non -Domestic Substances List
NIOSH -- National Institute for Occupational Safety and Health
Date or issue/Date ofrevesion : 10115/2014. Dare of previous issue 10/2a014. Version : 0.02 17/12
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nyarogen
Section 16. Other information
TOG -Canadian Transportation of Dangerous Goods Act and Regulations
TLV-Threshold Limit Value
TSCA -Toxic Substances Control Act
WEEL -Workplace Environmental Exposure Level
WHMIS -Canadian Workplace Hazardous Material Information System
References Not available.
v Indicates information that has changed from previously issued version.
,Notice to reader
To the best of our knowledge, the information contained herein is accurate. However, neither the above-named
supplier, nor any of its subsidiaries, assumes any liability whatsoever for the accuracy or completeness of the
information contained herein.
Final determination of suitability of any material is the sole responsibility of the user. All materials may present
unknown hazards and should be used with caution. Although certain hazards are described hereJn, we cannot
guarantee that these are the only hazards that exist.
Date of issue/Date of revision : 10/15/2014. Date of previous issue : 1012/2014. Version : 0. 02 12112
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WELL CONSTRUCTION RECORD
(Page 41 of 142)
Chant Fairchild Industrial Products
Frajcct Name Deep Well installation
Number 042-05-154
Drill Contractor Tr con En meeting Consultants. lira.
Drill Method
Drilling Started 10/20/05 -Ended 10/20/05
Location Winston-Salem, NC Logged By
DEPTH
FEET
SAMPLE
NO.
10-
7
15-
20—
LOG OF BORING DW-16
SHEET 1 OF 1
Elevation --
Total Depth 3.S.0
ATO 20,0
Depth To Water
DESCRIPTION
rcrete SOW
Lease Orenge•Brawn Silty Coarse To Fine -SAND - F€ I (Hold, Cohesive)
rown Medium To Fine SandySILT- HI (Moist, Coheeivo)
Dense Grey-areen 61Ity Medium To Fine SAND - Fifl (Mast, Cohesive)
Danes Light Gray Silty Coarse To Flee SAND - Residual (Moist, Nun-CahesiLe)
—10
—15
2
Soft Weathered Rook Samples As Light Brown Coarse To Fine BAND (Saturated, Nan-Coies(Va)
Auger Refusal
Non Engineering Consultants, inc.
313 Galllrrlore Dairy Road
Greenebaro, North Carolina 27409
Telephone: [phone]
Fax: [phone]
Bottom of hole at 35 feat
Remarks
l_Ses tosyr *wet for symbols and abbreviations used above.

PRECO NSTRUCTIO N REPORT
(Addition of Passive Hydrogen
Injection System in DW -16)
Site:
ROTORK, FORMERLY FAIRCHILD INDUSTRIAL PRODUCTS COMPANY
3920 WESTPOINT BOULEVARD
WINSTON':"SALEM, NORTH CAROLINA
SITE ID NO. NONCD0001700
Submitted To:
MR. MATTHEW AUFMAN
NCDENR -DIVISION OF WASTE MANAGEMENT
INACTIVE HAZARDOUS SITES BRANCH -REC PROGRAM
217 WEST JONES STREET
RALEIGH, NORTH CAROLINA 27603
Prepared By:
ENVIROTRAC LTD
7343 WEST FRIENDLY AVENUE, SUITE J
GREENSBORO, NC 27410
[phone]
MAY 2015
A Full Service Environmental Consulting
and Contracting Firm
EnvTro-1-ra-c
May 22, 2015
Mr. Matthew Aufman
NCDENR -Division of Waste Management
Inactive Hazardous Sites Branch -REC Program
217 West Jones Street
Raleigh, North Carolina 27603
Reference: Preconstruction Report (Addition of Passive Hydrogen
Injection System in DW-16)
Rotork, Formerly Fairchild Industrial Products Company
3920 Westpoint Boulevard
Winston-Salem, North Carolina
Site JD . No. NONCD0001700
Dear Mr. Aufman:
Environmental Services
EnviroTrac Ltd. (EnviroTrac) is pleased to provide the enclosed Preconstruction Report for the
referenced site. This report has been certified by the RP and RSM. The Component Checklist -
Preconstruction Report is included as Appendix A. A Work Phase Completion Form No. WPC-
IV is included as Appendix B. Should you have questions, or require additional information
regarding this submittal, please do not hesitate to contact Chris Hay at [phone] or
[e-mail].
Very truly yours,
ENVIROTRAC LTD
Firm License No. C-457
ffeiL .1faj
Gail G. Hay, PE
Senior Engineer
a.,¾
Christopher W. Hay, El, RSM
Principal
Enclosure
Cc: Mr. Philip LeRoy, Ares Management w/enc.
Mr. Mike Rogers, NCDENR UIC Program
7343 West Friendly Avenue, Suite J, Greensboro, North Carolina 27410 I Office: [phone] I Fax: [phone]
www .envirotrac.com
to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties
for willfully submitting false, inaccurate or incomplete information."
\ gur,---,ore a1 sit 4.4essor b1
Nuneof Remedia ing Party .gyp P.t1 L' pQ; .L ' �"
e57
Signature d� 0,41W.Le Ec
0 rca r
NOTARIZATION
13aIO fl 1 (Enter State)
�ht'i5 COUNTY
C-illWiti1 MAYaveT
y0A of W\ i3too nsielYl
REC PROGRAM DOCUMENT CERTIFICATION FORM - PAGE I OF 2
IFISB SITE NAME Ratark/Fairchifd Industrial Products Company - NONCD0001700
DATE & NAME OF DOCUMENT 5/22,t5 Preconstruction Report
TYPE OF SUBMITTAL (circle all that apply): Cgepo Work plan, Work Phase Comp. Statement, Schedule Change
REMEDIATING PARTY DOCUMENT CERTIFICATION STATEMENT (.0306(B)(2))
%A1O.( r� i'►tij c# f �y •.et 'Cic; r-c1' c+ �f..y CAF.•1 F t COIF u^.,444.1 °t s
^SueecS a Mom+ j++^ +'o
"I certify under penalty of law that I have personally examen anti am amiliar with the in a s Al IA 4
su mittal, including any and all documents accompanying this certification, and that, based on my inquiry of those ,,,,•-4-...1
individuals immediately responsible for obtaining the information, the material and information contained herein is ,fte'rh".*1
Ylot6W �uQ c, oY b l'a etfiC£Y rg\etlrlq
\lo kk o yl ly the idle i r j � 11RdiV1.Au tq virV10 S1final
Ap WVYterl�- !o wlmtkl .< CO' r�ttf of t 5 a tt h t anti nal t
AliuMmteSS, oleCu o Va1ta1 o f ' AAA _ plowmetnt.
a Notary Public of said County and State, do hereby certify that
did personally appear and sign before me this day, produced proper identification
in the form of NI d weirs. 11X016eJ , was duly sworn or affirmed, and declared that, to the best of his or-ier.
knowledge and belief, after thorough investigation, the information contained in the above certification is true and
accurate, and he or -she then signed this Certification in my presence.
WITNESS my hand and official seal this V- day of 6' t yc flt
L certify ulndtev peloi pcvikti uvlAtv nt viral 1� Cr1A*rrn6'k t`Yv`1 tAL
AYYYI (OFFICIAL SEAL)et1 ,
11vi
Notary Futile (a n ature)
Nly commission expires: Cif W41 .
Document Certification Form No. DC - 1
(Revised &111)
GILLIAN WNW
Ccmmisslce • tals9769
Notary Public - Ciblornii
Los MQslss County
Comm, fxpirso SsP �B. 2016

CERTIFICATION
In connection with Ares Capital Corporation's ( .. ARCC") Preconstruction Report dated
on or about May 22, 2015, the undersigned hereby certifies that the material and
infonnation contained in the submittal, which has been prepared by an expert advisor
retained by ARCC, for the Rotork/Fairchild Industrial Products Company Winston-
Salem, North Carolina EnviroTrac Project No. 97626, is to the best ofmy knowledge and
belief true, accurate and complete. The undersjgned hereby acknowledges that the ARCC
representative signing the Statement is relying on this Certification in order to make his_
or her certifications required in the Statement.
By:~
Nam~
Dated: May 29, 2015
:,.•. '!';: I •Jt ·1 • •••,., ... ,• ... •j't. ~. !
'•
REC PROGRAM DOCUMENT CERTIFICATION FORM - PAGE 2 OF 2
IHSB SITE NAME i- otarivt-aircniia inausulai rraauctS urompany - NUINUUUUU'I rUU
DATE & NAME OF DOCUMENT 5/22r15 1-reconstruction rcepori
TYPE OF SUBMITTAL (circle all that apply) epo Work plan, Work Phase Comp. Statement, Schedule Change
REGISTERED SITE MANAGER CERTIFICATION OF SIGNATURES
As the Registered Environmental Consultant for the Site for which this filing is made, 1 certify that the signatures included
herewith are genuine and authentic original handwritten signatures andlor true, accurate, and complete copies of the genuine and
authentic original handwritten signatures of the persons who purport to sign for this filing. I further certify, that I have collected
through reliable means the originals andlor copies of said signatures from the persons authorized to sign for this filing who, in
fact, signed the originals thereof. Those persons and I understand and agree that any copies of signatures have the same legally
binding effect as original handwritten signatures, and I certify that any person for whom I am submitting a copy of their signature
has poovided me with their express consent to submit said copy. Additionally, t certify that I am authorized to attest to the
genuineness and authenticity of the signatures, both originals and any copies, being submitted herewith and that by signing
below, I do in fact attest to the genuineness and authenticity of all the signatures, both originals and copies, being submitted for
this filing.
Chrs Hay
Name of Re
Srgaat ` 'z egistered Sit ianager
Date !`
REGISTERED SITE MANAGER DOCUMENT CERTIFICATION STATEMENT (.0306(b)(1))
"1 certify under penalty of law that I am personally familiar with the information contained in this submittal, including any and
all supporting documents accompanying this certification, and that the material and information contained herein is, to the best of
my knowledge and belief, true, accurate and complete and complies with the Inactive Harardous Sites Response Act N.C.G.S.
130A-310, et seq, and the remedial action program Rules I5A NCAC 13C .0300. I am aware that there are significant penalties
for willfully submitting false, inaccurate or incomplete information."
Chris Hay
Name
Registered Sit
Manager
SigTure of Registered Sit
tanager Date 66
NOTARIZATION
(Enter Stale)
COUNTY
, a Notary Public of said County and State, do hereby certify that
Vtekti did personally appear and sign before me this day, produced proper
identification in the form of pstr.,- , was duly sworn or affirmed, and declared that, he or she is the
duly authorized environmental consultant of the remediating party of the property referenced above and that, to the best
of his or her knowledge and belief, after thorough investigation, the information contained in the above certifications is
true and accurate, and he or she then signed these Certifications in my presence.
WITNESS my hand and official seal this '`-day of , o►�,
Notary Public [signature]
My commission expires: 5/r, / r`t
Document Certification Form No. DC -
(Revised 8/11)
(OFFICIAL SEAL)
ANNAMARIE BLAUSER
NOTARY PUBLIC
Stokes County
North Caruflrta
My COFnmission Expire* $/it/ aci`k

Effitr" Fori'a
E vh'anmen:d1 Smirks
A Report Prepared for:
Mr. Philip LeRoy
Ares Management, LLC
2200 Pennsylvania Avenue NW 1 Suite 600-W
Washington, DC 20037
PRECONSTRUCTION REPORT
(Addition of Passive Hydrogen Injection System in DW-16)
ROTORK, FORMERLY FAIRCHILD INDUSTRIAL PRODUCTS COMPANY
WINSTON-SALEM, NORTH CAROLINA
Prepared by:
Gail G. Hay, PE
Senior Engineer
Reviewed by:
C lytt‘ 441\
Christopher,W Hay, El, RSM
Principal
EnviroTrac Ltd
7343 W. Friendly Avenue, Suite J
Greensboro, North Carolina 27410
Phone: [phone]
May 22, 2015
EnviroTrac No. 11.990015.00
1.990015.00 1 May 22, 2015
2015 EnviroTrac

EnvironmMta! Services
ROTORK, FORMERLY FAIRCHILD INDUSTRIAL PRODUCTS COMPANY
SITE ID NO. NONCD0001700
SITE INFORMATION
Name:
Address:
Contact:
_ Telephone:
LAND OWNERSHIP
Name:
Address:
Contact:
Telephone:
RESPONSIBLE PARTY
Name:
Address:
Contact:
Telephone:
May 22, 2015
Rotor:J<, Formerly Fairchild Industrial Products Company
3920 Westpoint Boulevard
Winston-Salem, North Carolina 27103
Mr, John Seaiey
[phone]
Fawn Industrial, LLC
c/o CB Richard Elli~ of VA
101 Centreport Drive, Suite .160
Greensboro, North Carolina 27409
Ms. Lori Starnes
[phone]
Ares Capital Corporation
245 Park. Avenue 144th Floor
New York, New York 10167
Mr. Philip Leroy
(2l2) 710-,2169
RE.GISTERED ENVIRONMEN1AL CONSUL TANT
Name: EnviroTrac Ltd
Address: 7343 W. Friendly Avenue, Suite J
Contract/RSM:
Telephone:
Greensboroj North Carolina 2741 O
Mr. Christopher W. Hay, RSM
[phone]
SEAl-ANO SIGNATURE OF C~RTIFYING PROFESSIONAL GEOLOGIST
I, Cr. · ·· · .
cont
11.990015.00
© 2015 EnviroTrac
eologist for EnviroTrac Ltd. do certify that the .information
accurate to the best of my knowledge.
o practice geology In North Carolina. The certification
number of the company is C-457.
ii May 22, 2015
EnvTro----1ra~c
Erwironmental Se<vices
TABLE OF CONTENTS
SECTION I-PRECONSTRUCTION REPORT ............................................................................ 1
.0306(m)(1) Treatability Studies and Site Characterization ................................................. 1
.0306(m)(2) Final Engineering Design Report ..................................................................... 1
.0306(m)(3) Permits and Approvals .................................................................................... 2
APPENDICES
A Component Checklist -Preconstruction Report
B Remedial Design Completion Certificate (Work Phase Completion Form No. WPC-IV)
C Passive Hydrogen Injection System Diagram
D Notification of Intent to Construct or Operate Injection Wells
11.990015.00 iii May 22, 2015
© 2015 EnviroTrac
EnvTro ...... , ... ra-c
Environmental Services
SECTION I -PRECONSTRUCTION REPORT
.0306{m){1) Treatability Studies and Site Characterization
Based on historical analytical results, decreasing trends in concentrations of tetrachloroethene
(PCE) across the site suggest that Hydrogen Release Compound (HRC) is driving
dechlorination of the chlorinated hydrocarbons in the injected area. with the exception of
monitoring well DW-16. The purpose of the enhancement to the current remediation regime is
to target the localized area of elevated PCE concentrations in monitoring well DW-16 at the site.
Installing a passive hydrogen injection device in the well would increase the degradation rate of
chlorinated hydrocarbons but still allow the well to be used as a monitoring point.
Through the course of the remedial action, it has been demonstrated that the introduction of
hydrogen has aided in the degradation of chlorinated hydrocarbons in groundwater at the site.
This alternative hydrogen delivery method was chosen to provide a continuous supply of
hydrogen directly into DW-16 to target elevated PCE concentrations at the bedrock surface.
The previous injection phases decreased PCE concentrations at this location (DW-16);
however, it appears an insufficient supply of hydrogen reached the vicinity of DW-16 .
. 0306{m){2) Final Engineering Design Report
The passive hydrogen injection system is proposed to be installed into DW-16. The hydrogen
delivery system produces a convection current to distribute dissolved hydrogen throughout the
screened interval of the well. A curtain of hydrogen rich water disperses around the well into the
adjacent groundwater forming a treatment zone allowing enhanced bioremediation to degrade
the target contaminants. The hydrogen injection system provides dissolved hydrogen to the
treatment wells at a concentration of 2.2 to 2.4 parts per million (ppm) depending on the
immersion depth of the unit in groundwater. The dissolved hydrogen concentration achieved in
the injection well depends on the height of the water column in the well. Each atmosphere of
pressure allows for a maximum of approximately 1.6 ppm of dissolved hydrogen. Hydrogen
concentrations were estimated based on the approximate pressure at the installation depth of
the injection wells. The calculations were made with the assumption that 1.6 ppm of hydrogen is
dissolved in the groundwater per atmosphere of pressure.
11.990015.00 Page 1 of 2 May 22, 2015
© 2015 EnviroTrac
EiwTroirac
Environmental Service~
Hydrogen is delivered to the treatment well from a compressed gas cylinder at a regulated
pressure and rate. The hydrogen cylinder will be secured to a concrete block wall near the well
inside the building and grounded. A hydrogen delivery system diagram is included in Appendix
C. The hydrogen cylinder regulator will be set to 20 pounds per square inch. Standard grade
hydrogen (99 percent or greater) will be supplied to the diffuser through one quarter inch
diameter Parflex 55L T tubing. The Parflex tubing will be connected to approximately 40 feet of
silicone tubing secured to a PVC frame. The silicone tubing is porous enough to allow hydrogen
to permeate the tubing at a size that readily dissolves into the groundwater. The hydrogen
diffuser will be placed inside the existing monitoring well DW-16.
Following installation of the hydrogen diffusion device, the site will be visited monthly to record
hydrogen levels, regulator pressures, and replace hydrogen cylinders, if necessary. The
hydrogen consumption in the injection well will be tracked to estimate the remaining service life
of the hydrogen cylinders. Hydrogen consumption will be recorded. The pH, temperature,
conductivity, oxidation-reduction potential, and dissolved oxygen in monitoring well DW-16 will
be monitored monthly. EnviroTrac will collect groundwater samples from monitoring well DW-16
during the September sampling event and semi-annually thereafter concurrent with the ongoing
monitoring schedule. EnviroTrac will summarize the hydrogen consumption, groundwater
analytical results compared to historical and 2L Standards, groundwater flow map, and
conclusions and recommendations in the Semi-Annual Remedial Action Progress Reports._ The
performance of the hydrogen delivery system will be evaluated by collecting groundwater
samples semi-annually from the injection well and comparing contaminant levels to previous
laboratory analytical results.
The passive hydrogen injection system will be installed following receipt of an injection well
permit from the UIC Program, which is anticipated in June 2015. The initial monitoring event will
be performed in conjunction with the regularly scheduled semi-annual remedial action
monitoring in September 2015. Performance monitoring and evaluation of results will be
reported semi-annually .
. 0306(m)(3) Permits and Approvals
A Notification of Intent to Construct or Operate Injection Wells has been prepared and is included
in Appendix D. No additional permits or approvals are required to complete the remedial action.
11.990015.00
©2015 EnviroTrac
Page 2 of 2 May 22, 2015
APPENDIX A
COMPONENT CHECKLIST -PRECONSTRUCTION REPORT
Preconstruction Report Site Name Rotork, Formerl y Fairchild Industrial Products
Location Winston-Salem . North Carolina
Name and Date of Document Preconstruction Re port dated Ma y 2015
Preparer/Reviewer~C=h~ris~H~a=--y'-------------
Component Checklist -Preconstruction Report
REC Rules (15A NCAC 13C)
Note: The checklist and REC Program Implementation Guidance should only be used as a supplement to the REC Rules.
NOTIFICATION REQUIREMENTS:
Report to REC Program staff within 24 hours upon discovery of any of the following, if applicable [.0305(b )(2)&(3)]:
• an imminent hazard at the site ---
• ___ off-site migration of hazardous substances
•
•
---
---
the presence of sensitive environments
mixed chemical & radioactive wastes
PRECONSTRUCTION EVALUATION AND DOCUMENT CONTENT -J.0306(m )j :
See Guidance for exceptions to preparing Preconstruction Reports.
X .0306(m)(l)
X .0306(m)(2)
- X . 0306(m)(3)
Treatability studies and site characterization. Provide all treatability study reports and
additional site characterization reports (performed since the remedial investigation). These should
be provided in an appendix and summarized in the text.
Final engineering design report. Report should include narrative description of process
design, final plans and specifications, and an updated project schedule. Note: The remedy
described in this report must be consistent with the remedy proposed in the RSM-certified RAP .
Permits and approvals. Provide copies of all registrations , permits, and approvals in an
appendix. Note: The remediating party and the REC must obtain all necessary permits and
approvals .
SCHEDULE AND CERTIFICATIONS:
X
X
X
X
.0306(b)(l-2) Preconstruction Report has been properly certified by the RP and RSM.
Ensure proper document certification (Forms DC-1 and DC-11 downloadedfiw1t the website),
notary and dates. Ensure that date o(RSM signature fo llows date o(RP signature .
. 0306(b)(5) Preconstruction Report includes the remedial design work phase
completion statement. Ensure that the proper work phase completion statement
(Form WPC-JV) is included.
.0306(b)(4) Preconstruction Report will be/is certified as complete (and submitted to REC
Program staff for the public record) prior to initiating remedial construction.
_0302(1) Preconstruction Report will be/is submitted to the REC Program staff within
30 days of certification. All documents to date have met the milestones
identified in .0302(1)(1-4).
Page 1 of 1 Rev. November 2014
APPENDIXB
REMEDIAL DESIGN COMPLETION CERTIFICATION
(WORK PHASE COMPLETION FORM No. WPC-IV)
REMEDIAL DESIGN COMPLETION CERTIFICATION
15A NCAC 13C.0306(b)(5)(D)
Media (check all that apply): ❑ All Media ❑ Soil ® Ground water ❑ Surface water ❑ Sediment
REC is in compliance with both 15A NCAC 13C .0305(b)(2) and .0305(b)(3): [check]
Site Name Rotork, Formerly Fairchild Industrial Products
County
Forsyth
Site lD No. NONCD0001700
Street Address 3920 Westpoint Boulevard
Winston-Salem, NC
The remedial design, which is the subject of this certification has, to the best of my knowledge, been
completed in compliance with the Inactive Hazardous Sites Response Act N.C.G.S. 130A-310, et
seq. and the remedial action program Rules 15A NCAC 13C .0300. I am aware that there are
significant penalties for willfully submitting false, inaccurate or incomplete information.
/e/L4)/45°—
RSM Signature Date
Christopher Hay
RSM Name
EnviroTrac Ltd
Y
REC Name
00177
REC No.
NOTARIZATION
(Enter State)
SIbLQ,5 COUNTY
yy
Oicsi
identification in the form of Ark.des-5 ki,v .e„e, , was duly sworn or affirmed, and declared that, he
or she is the duly authorized environmental consultant of the rernediating party of the property referenced
above and that, to the best of his or her knowledge and belief, after thorough investigation, the
information contained in the above certification is true and accurate, and he or she then signed this
Certification in my presence.
WITNESS my hand and official seal this leday , 15
7343 West Friendly Avenue, Suite J
Mailing Address
Greensboro, NC 27410
City, State, ZIP
, a Notary Public of said County and State, do hereby certify that
did personally appear and sign before me this day, produced proper
Notary Public (signature)
My commission expires: 5).
(OFFICIAL SEAL)
ANNAM► RIE BLAUSER
NOTARY PUBLIC
Stokes County
North Cardins My fib^ Expires it►[ u•t9
Work Phase Completion Form No. WPC — IV
(Revised 12113)

APPENDIXC
PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
rn
n
nviro ra
Environmental Services
PASSIVE HYDROGEN INJECTION SYSTEM DIAGRAM
PROJECT Rotorkt Formerly Fairchild Industrial Products
DEPTH TO WATER FROM
PROJECT NUMBER 11.990015.00 TOP OF WELL CASING 21.80 feet
WELL NUMBER DW-16
WATER LEVEL ELEVATION 72.09 feet ;site datum;
ELEVATION OF TOP OF WELL CASING 93.89 feet (site datum; WATER LEVEL MEASURED ON 03/11/2015
HYDROGEN INSTALLED ON June 2015 - Proposed NOTE: DRAWING NOT TO SCALE
60"
STEEL WELL GROUNDING _
VAULT ROD
REGULATOR/
PRESSURE
GAUGE
HYDROGEN
CYLINDER
TL
Ti ■
30'
35'
26'
SUPPLY LINE
SUPPORT CABLE
TOP OF FILTER PACK
TOP OF SCREEN
HYDROGEN
DIFFUSER
BOTTOM OF WELL
J
LT_
Q
U
ENVIROTRAC
— 7343
W.
FRIENDLY
AVE,.
SUITE
J
GREENSBORO.
NC
PH:
336.763.6025
FAX:
336.763.6034
www.envirotrac.com

APPENDIX D
NOTIFICATION OF INTENT TO CONSTRUCT OR OPERATE INJECTION WELLS