WI0400466_DEEMED FILES_20170424

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North Carolina Department of Environmental Quality-Division of Water Resources
INJECTION EVENT RECORD (IER)
Permit Number WI0400466
Were any wells abandoned during this injection
Permit Information event?
D Yes ~ No
S geedway LLC
Permittee If yes, please provide the following information:
S geedway 7934 (Former WilcoHess 302} Number of Monitoring Wells
Facility Name
Number of Injection Wells
2005 E Wendover Ave. Greensboro . Guilford Co.
Facility Address (include County) Please include a copy of the GW-30 for each well
abandoned.
Injection Contractor Information
4. Injectant Information
Mid-Atlantic Associates Gravi ty in jection of agg roximatel ~ 125 gallons of 4% solution
Injection Contractor I Company Name of EnviroClean surfactant intQ existin g monitorin g well MW-7
on 3/13/17 . with subse guent 96-hour Mobile Multi-Phase
Street Address 409 Ro !!ers View Ct Extraction {MMPE } recove rv event conducted from 3/20/17 to
3/24/17.
Raleigh NC 27610 lnjectant(s) Type (can use separate additional sheets
City State Zip Code if necessary
Concentration 4%
l2.12...) 250-9918
Area code -Phone number If the injectant is diluted please indicate the source
dilution fluid. Citv of water gotable sugg ly
Well Information
Total Volume Injected (gal) 125 -Gallons
Number of wells used for injection 1 Volume Injected per well (gal) 125 -Gallons
Well IDs MW-7 5. Injection History
Were any new wells installed during this injection Injection date(s) March 13 . 2017
event? UO!i:>8S suonruedo lei.I ~,Be~ . . 1 of 1 D Yes ~ No ~nenoJaie , f', · lnJect10n number (e.g. 3 of 5)
If yes, please provide the following informatl\@:Z J,. g H fi; Is this the last injection at this site?
D Yes ~ No -TBD will evaluate results.
Number of Monitoring Wells
8MQ/0300N/Q3 I\J ; OIi ~ DO HEREBY CERTIFY THAT ALL THE
Number oflnjection Wells INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
Type of Well Installed (Check applicable type): INJECTION WAS PERFORMED WITHIN THE
D Bored D Drilled D Direct-Push STANDARDS LAID OUT IN THE PERMIT.
D Hand-Augured D Other (specify)
SIGNATURE OF INJECTION CONTRACTOR DATE
Please include a copy of the GW-1 form for each
Recerveo1Ncoe01awR well installed.
PRINT NAME OF PERSON PERFORMING THE INJECTION
i-1t't(
Submit the original of this form to the Division of Water Resources within 30 days of injection.
2 4 ZDl l orm UIC-IER
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-64<jf8
. Water Quality Rev. 3-1-2016
g1ona1 Operar
rons Section
Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0400466
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Speedway #7934
Location Address
2003 E Wendover Ave
Greensboro
Owner
Owner Name
Speedway LLC
Dates/Events
NC
Orig Issue
2/28/2017
App Received
2/21/2017
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
27401
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
2/28/2017
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
John H. Helms
500 Speedway Dr
Enon
County
Guilford
OH
Issue
2/28/2017
Effective
2/28/2017
45323
Expiration
Request ed /Received Events
Streamlndex Number Current Class Subbasin
Shrestha. Shristi R
From: Shrestha, Shristi R
Sent: Tuesday, February 28, 2017 2.05 PM
To: 'choffman©maaonline.com'
Cc: Knight, Sherri
Subject: WI0400466 NOI Speedway 7934
Thank you for submitting the Notice of Intent to Construct or Operate Injection Wells (IVOI) for the above referenced
site.
Please remernber to submit the following regarding this injection activity:
1) 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 [e-mail] 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 WI0400466. This number is also referenced in the subject line of this email. You may if you
wish, scan and send back as attachments in reply to this email, as it will already have the assigned deemed permit
number in the subject tine.
Thank you for your cooperation.
Shristi
Shristi R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi.shresthaCa ncdenr.gov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
thing Com are
Email correspondence to and from ih+s address is subject to the
North Carolina Public Record's Law and may be disclosed to third parties,

Shrestha, Shristi R
From; Shrestha, Shristi R
Sent: Tuesday, February 28, 2017 2:03 PM
To: Knight, Sherri
Subject WI0400466 NOI Speedway 7934
Attachments: NOI.pdf; Maps.pdf
Please find the attached NO!.
Shristi
Shrlsti R. Shrestha
Hydrogeologist
Water Quality Regional Operations Section
Animal Feeding Operations & Groundwater Protection Branch
North Carolina Department of Environmental Quality
919 807-6406 office
shristi,s h resthaia1ncdenr.Uov
512N. Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699 1636
' Noth- C tires
Email corresporndenc to and from tfris address is subject to the
!North Carolina Public Records Law and may be dirc/osed to third parties.

tspeedway
----------------------Speedway LLC
February 16, 2017
RECEIVED/NCDEQ/DWR
FEB 21 2017
Water Quality Regional
Operations Section
Division of Water Resources
Underground Injection Control Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Speedway Office
P.O. Box 1500
Springfield, OH 45501
Teleohone 937-864-3000
Subject: NOTIFICATION OF INTENT TO CONSTRUCT OR OPERA TE INJECTION WELLS
SPEEDWAY 7934 (FORMER WILCOHESS 302)
2005 EAST WENDOVER AVENUE
GREENSBORO, GUILFORD COUNTY, NORTH CAROLINA
DWM INCIDENT NO. 28414
MID-ATLANTIC JOB NO. 000R1143.29
Dear Mr. Rogers:
Speedway LLC is pleased to submit the attached Notification of Intent to Construct or Operate
Injection Wells for the Speedway 7934 (former WilcoHess 302) facility located at 2005 East
Wendover Ave. in Greensboro, North Carolina. If you have any questions or need additional
information, please feel free to contact me at [phone] or Chuck Hoffman with Mid-
Atlantic Associates, Inc. at [phone].
Sincerely,
SPEEDWAY LLC
lactr1y~
Keith A Hughes
Advanced Environmental Representative
Enclosures: Notice of Intent to Construct or Operate Injection Wells
Attachment A -Injection Zone Maps (Section H)
Attachment B -Safety Data Sheet (Section J)
Attachment C -Well Construction Records (Section K)
An Equal Opportunity Employer
North Carolina Department of Environmental Quality -Division of Water Resources
NOTIFICATION OF INTENT (NOi) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of ISA NCAC 02C .0200. This form shall be submitted at least 2 WEEKS prior to injection.
AQUIFER TEST WELLS U SA NCAC 02c .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION U SA NCAC 02C .0225) or TRACER WELLS O SA NCAC 02C .0229 ):
1) Passive Injection Systems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods.
2) Small-Scale Injection O perations -·Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet.
3) Pilot Tests -Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation, and where the
surface area of the injection zone wells 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 In iection Wells -Used to inject ambient air to enhance in-situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submitta/s Will Be Returned As Incomplete.
DATE: February 16 . 2017 PERMIT NO. IN L O Cf-0 0 C/-' 0 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERA TED
B.
C.
(1)
(2)
(3)
(4)
(5)
(6)
___ Air Injection Well ...................................... Complete sections B through F, K, N
___ Aquifer Test Well ....................................... Complete sections B through F, K, N
--~Passive Injection System ............................... Complete sections B through F, H-N
--'X=-=-----_Small-Scale Injection Operation ...................... Complete sections B through N
___ Pilot Test. ................................................ Complete sections B through N
___ Tracer Injection Well ................................... Complete ~N@fi)EQ/D WR
STATUS OF WELL OWNER: Business/Organization FEB 21 2017
Wat,.~r Oua/;ty R '
WELL OWNER(S) -State name of Business/Agency, and Name and Title of persi:Mi~~;;9fority to
sign on behalf of the business or agency:
Company Name S peedway LLC
Delegated Signatory Authority: -M~r~. ~Jo~hn~M~. H=e=lm=s~----------------
Mailing Address: --~5~00~S.._p~ee~d~w~a'"'"y_D_r~iv~e~---------------------
City: Enon State: OH Zip Code: 45323 County: Clark
Day Tele No.: ----"9-"'3-'-7-....,,8=6=-3-.;.6-=-5 =15'-----Cell No.: 937-206-2431
EMAIL Address: _____________ _ Fax No.: ---"9-=-3-=-7---"'8=63=--=60~7---=8 ___ _
Deemed Permitted GW Remediation NOi Rev. 3-1-2016 Page I
D. PROPERTY OWNER(S) (if different than well owner)
Company Name ___ S=a=m=e~as~W~e=ll~O~wn~e=r _____________________ _
Mailing Address:--------------------------------
City: ____________ State: __ Zip Code:, _______ County:, _____ _
Day Tele No.: ______________ _ Cell No.: __________ _
EMAIL Address: _____________ _ Fax No.: __________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: ___ C=h=ar=l=e=s =B~-=H=o=f:fin=a=n~, ~P~ro-ie~c~t ~G~e~o~lo...._g=is~t _______________ _
Company Name ---------'M=id=--.c...A=t=lan=tic=----"-'A=s=so=c=ia=t=es=·=In=c=·-------------------
Mailing Address: 409 Ro gers View Court
City: Raleigh State: NC Zip Code: 27610 County: Wake
Day Tele No.: (919 ) 250-9918 Cell No.:. __ ....,(-=8-'-'43~)-=-9-=-08=--=-38~8~9 __ _
EMAIL Address: __ -------'c=h=o-=ffm=a=nc..;;•('---'1 m=aa=o=n=li=n=e-=c=01=n'-----Fax No.: --~<9~1=9~) =25~0~-9~9~5-=-0 __ _
F. PHYSICAL LOCATION OF WELL SITE
(I) Facility Name & Address: S peedway 7934 (Former WilcoHess 302)
2005 East Wendover Avenue
City: ---'G=r=e=en=s=b=o=ro'----_______ County,_: ___ G=u=i=lfi=o~rd=--__ .Zip Code: ---=2'"'"7~4=05~
(2) Geographic Coordinates: Latitude**: _3~6~_0 ~' 14 N II or 0
Longitude**: -79 ° ~' 34 W" or 0
Method of Collection: __ G=o=o"-'g~le=-=E=art=h=S-=-oftw==ar=-=e'-----------
**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
Note: There have been two previous releases at the site, with the source areas identified in the vicinity of
monitoring wells MW-I (gasoline release) and MW-7 ( diesel fuel release). The site is currently regulated by the
North Carolina Department of Environmental Quality (NCDEQ), Division of Waste Management (DWM),
Underground Storage Tank (UST) Section. The site is ranked intermediate risk and, therefore, the current
groundwater cleanup goals are the North Carolina Gross Contamination Levels (GCLs) and removal of free
product. Diesel fuel free product remains present on the water table at well MW-7, and dissolved-phase
benzene concentrations exceed GCLs at wells MW-1 and MW-2 . As such, the "area of the contaminant plume"
indicated below refers to the approximate area of the diesel fuel free product plume and the approximate area of
the gasoline plume exceeding GCLs.
Land surface area of contaminant plume:_4_,_,.-=-00=0=-----·square feet
Land surface area of inj. well network:_-=2-=-00=--____ square feet (:s 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 0.05% (must be :S 5% of plume for pilot test injections)
Deemed Permitted GW Remediation NOi Rev. 3-1-2016 Page2
H. INJECTION ZONE MAPS -Attach the following to the notification. Provided in Attachment A
(1) Contaminant plume map(s) with isoconcentration lines that show the horizontal extent of the
contaminant plume in soil and groundwater, existing and proposed monitoring wells, and existing and
proposed injection wells; and
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
I. DESCRIPTION OF PROPOSED INJECTION ACTMTIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
Residual diesel fuel free product (a pp roximate thickness of 0 .13 feet) remains present on the water table at the
site at well MW-7 . and dissolved-phase groundwater contaminant concentrations exceed the North Carolina
Gross Contamination Levels (GCLs) in wells MW-1 and MW-2. Mid-Atlantic pro poses to in ject EnviroClean
(EC-165 ) at the site to enhance free product recove ry at well MW-7 and stimulate in-situ bioremediation at well
MW-1. EnviroClean (EC-165 ) is a common cleanu p/miti gation a gent that can be a pp lied as both an emulsify in g
a gent for free product recove ry and biosurfactant for dissolved-phase groundwater remediation. It is estimated
that a pp roximatel y 125 gallons of 4% solution of EnviroClean will be gr avity in jected into wells MW-I and
MW-7 over an estimated period of u p to 8 hours on-site. A 96-hour Mobile Multi-Phase Extraction (MMPE)
event will then be conducted at the site a pp roximatel y one week followin g com pletion of the surfactant in jection
event. with post-MMPE free product gaugin g and gro undwater sam plin g activities conducted a pp roximatel y two
weeks followin g com pletion of the MMPE event.
J. APPROVED INJECT ANTS-Provide a MSDS for each injectant. Attach additional sheets if necessary.
Provided in Attachment B
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found online at hltp ://de y.nc.!.wv/about/divisions/water-
resources/water-resources-11ermits/wastewater-branch/!.!.round-water-protection/gr ound-water-a nproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UJC Program for more info (919-
807-6496).
Injectant: --~E=n=v~ir~o~C=l~ea=n~E~C--1""6=5'------------------------
Volume of injectant: __ 1=2=5~G~al=lo=n=s~----------------------
Concentration at point of injection: ___ 4~¾~o ___________________ _
Percent if in a mixture with other injectants: ___________________ _
K. WELL CONSTRUCTION DATA Well Construction Records Provided in Attachment C
(1) Number of injection wells: ----=-O ___ P.roposed'--_-=2'--__ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NO! Rev. 3-1-2016 Page 3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
The existine well network will be used for performance monitoring. with monitorinc wells MW-i and MW-7
used for injection in March 2017. The injection event will take ataproximateb. 8 hours for completion. A 96-
hour Mobile Multi -Phase Extraction t1v1MPE f event will then be conducted at the site approximatel4 one week
following completion of the surfactant injection event. with post-MMPE free product uaucing and
groundwater samplinia activities conducted approximately two weeks following completion of the MMPE
event.
IVI. [MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 02L result from the injection activity.
The site is currently retiulated by the NCDEO DWM UST Section. Sampling of selected site monitoring wells
1NlW i� MW-2. MW-3. MW-3i. MW-7 MW-8 and MW-13 through MW-17) are performed on a semi-annual
schedule with results reported to the UST Section. Please note that EnviroClean is a ptoprietars blend of
wetter -based. biodegradable surfactants that was specificalh engineered as a cleanuplrnitisation agent and
vapor sttppressant for use on a wide range of hydrocarbon products. EnviroClean. in and of itself does not
cause or catalyze specific chemical reactions, nor does it contain an. bacteria cultures. The basic principle of
EnviroClean is to emuisif's and encapsulate hydrocarbon particles. As such. the injection activity is not
anticii%ated to result in violations of the NCGQS for additional compounds other than those already noted from
the previous gasoline and diesel fuel releases releases.
SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "1 hereby certify. norther penalty o/.law, that t am fwniliar with the information submitted in
this document and all attachments thereto and that, based on my inquiry of those individuals immediately
responsible for obtaining said information, I believe that the it forrnaltnn is true, accurate and complete. 1 am
aware that there are ,significant penalties, including the possibility of fines and imprisonment, for submitting
.Lill, itjortra hlion, I agree to construct, operate, maintain, repair, and i applicable, abandon the injection well
g id 1 relate)] a rl ur1enances in accordance with the 15.4 NCAC 02C 0200 Rules."
01r )A . tie I ��� MC( rw (( tc4-) eytV
grialture of , ppiirant Q Print or Type Full Name and Title
PROPERTY OWNER tit.the property is not owned b% the permit applicant):
"As (Airner of the properly on t.vhich the injection wells) are to be constructed and operated. I hereby consent
to allow the applicant to construct each infection it'ell as outlined in this application and agree Mat it .shall be
the responsibility of the applicant to ensure that the injection well() conform to the Well CoustruCtion
Stmidw-dx (1321 NVCAC' 02C' .0200i "
"Owner" means any person who holds the fee or other property rights in the well being constructed. A
well is real property and its construction on land shall be deemed to vest ownership in the land owner, in
the absence of contrary agreement in writing.
Signature` of Property Owner (if different fruit) applicant) Print or 'Type Full Name and Title
*An access a.rgreerrrent between the applicant and property owner may be submitted in lieu of a signature on this Joan.
Submit the completed notification package to:
D W R —1.11C Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Devcueil l'L.rmittcd GW Remeditstion NCH Re+.3.1-2016 Paged

ATTACHMENT A
INJECTION ZONE MAPS
(SECTION H)
:'rZ,Z..: i. L cEr.wC.W.P., A.5 ,R'. II
r ]�
=Y-
k . - .1I 4.M. TGkE.
it e
,I [Yurnr,Mi
AREA SHOWN
WITHIN NORTH CAROLINA
r1N
■
CONTOUR INTERVAL = 10 FEET
REFERENCES:
1, GREENSBORO, NC DIGITAL RASTER GRAPHIC FILE, USGS.
SCANNED FROM 1:24,000-SCALE TOPOGRAPHIC MAP:
GREENSBORO, NC, 1997, USGS.
2. INSET MAP DIGITAL DATA FROM 2002 NATIONAL TRANSPORTATION ATLAS,
BUREAU OF TRANSPORTATION STATISTICS, WASHINGTON, D.C.
SCALE: 1;12, 000
0 500 1,000
Feet
2,000
Mid Atlantic
Ereneering & Environmental Solutions
TOPOGRAPHIC SITE MAP
SPEEDWAY #7934
2005 EAST WENDOVER AVENUE
GREENSBORO, NORTH CAROLINA
DRAWN
BY:
DATE:
DECEMBER 2016
DRAFT
CHECK
ENG.
CHECK: 1L�'�
JOB NO:
000R1143.28
GIS NO:
01G-R1143.20-1
APPROVAL: (IVA
DWG NO: 1

A A'
785'-S8-B SB-5 -7!!5' -SB-4 .... --l A -,. I GP-4 --B I --I '-A --~ I I --B I I --B I I -I B -I I -ns·-I I -775'
6 -I I -
Ii ---I ----...,
I I ; -l --
""50UNE usr,7 ------~ ---
~ ------
; 765'~
-765' -._
._
--_, ---._
-._
-._
-._
755'-.__ 755' -._
-._
-._
------
0 30'
lilm; A CRUSH & RUN/AU.
RELATIVE ELE.VATIONS HAVE NOT BEEN SURVEYED B PREDOMINATELY TAN/BROWN SIL1Y CLAY HORIZONTAL SCAI.£: 1 •-30'
MID-ATLANTIC LITHOLOGIC CROSS-SECTION A-A' DRAWN ~ DATE: JUNE 2004
WILCO #302 BY:
DRAFT A S S O C I AT E S, INC. 2005 EAST WENDOVER AVENUE CHECK: ~ JOB NO: OOOR1143.0J
Engineering & Enviro11111ental Solutions GREENSBORO, NORTH CAROLINA ENG o6J CHECK: CAD NO: 01-11407-0J
REF'ERENCE: APPROVAL: 4,f DWG NO: ~S'
B
GP-6
773'
783'-
753'
Qa-7
al —a
sB-7
{ A �
1`{ A
S
[
RELATIVE ELEVA11ONS HAVE NOT BEEN SURVEYED
L— J
DIESEL usr
A CRUSH do RUN/FILL
8 PREDOMINATELY TAN/BROWN SJLTY CLAY
C PREDOMINATELY WHf t/: REY SAND
— 783'
1-
773'
783'
— 753'
0
HORIZONTAL SCALE f•- 20'
20'
MID -ATLANTIC
ASSOCIATES, INC.
Engineering & Environmental Solutions
LITHOLOGIC CROSS-SECTON B-B`
WILCO #302
2005 EAST WENOOVER AVENUE
GREENSBORO, NORTH CAROLINA
DRAWN 0J
BY:
DATE:
DUNE 2004
DRAFT
CHECK:
,JOB NO: 000R1143.03
ENG
CHECK:
CAD NO: 01-11430E-03
REFERENCE:
APPROVAL
DWG NO:G

ATTACHMENT B
SAFETY DATA SHEETS
(SECTION J)
SECTION I
E NV111:104t LEAN
SAFETY DATA SHEET
MATERIAL IDENTIFICATION
PRODUCT NAME / DESCRIPTION: EnviroClean
DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES
PO BOX 721090
OKLAHOMA CITY, OK 73I 72
DATE: 05/18/2015
PHONE: [phone]
EMERGENCY PHONE: [phone]
FUNCTION: industrial Cleaner and Remediation Agent
SECTION 2
HAZARD IDENTIFICATION
CLASSIFICATION:
Acute Toxicity- Oral
Category 4 1
Skin Corrosion/Irritation
Category 3
Eye Damage/Irritation
Category 2B
Target Organ Specific Toxicity: Single
Category 3
Target Organ Specific Toxicity: Chronic
Category 2
SIGNAL WORD:
WARNING!
HAZARD STATEMENTS:
Harmful if swallowed
Causes mild skin irritation
Causes eye irritation
May cause respiratory irritation
May cause damage to organs through prolonged or repeated exposure
PRECAUTIONARY STATEMENTS:
Obtain special instructions before use
Do not handle until all safety precautions have been read and understood
Use personal protective equipment as required
Avoid breathing dust/fume/gas/mist/vapors/spray
Use only outdoors or in a well ventilated area
Wash all exposed skin thoroughly after handling
Avoid release to the environment

E N VI RCl/CLEAN
Store in a well ventilated place
TOXICITY INFO:
See Section 11.
SECTION 3 HEALTH HAZARDS
CHEMICAL NAME %WIW CAS NUMBER
(Proprietary Formula)
Proprietary Blend of Ethoxylated Octylphenolic Surfactants
Non-ionic water based liquid blend, concentrate
This product does not contain any hazardous ingredients as defined by CERCLA and California's Prop. 65.
SECTION 4
FIRST AID
Potential acute health effects:
Eyes:
Skin:
Inhalation:
Ingestion:
May cause irritation with redness and pain.
May cause irritation with redness and pain.
Inhalation may cause irritation.
Ingestion may cause severe irritation, corrosion/ulceration, nausea, and vomiting.
Medical Conditions Aggravated by Exposure:
None known,
Eye Contact:
Skin Contact:
Inhalation:
Ingestion:
SECTION 5
In case of contact, immediately flush eyes with cool running water. Lift and
separate eyelids while flushing with plenty of water for at least 1.5 minutes. Get
medical attention.
Wash with soap and water. Get medical attention if irritation occurs. Wash
clothing before reuse. Destroy contaminated shoes.
Remove victim to fresh air and keep at rest in a position confortable for breathing.
If not breathing, give artificial respiration. If breathing is difficult, give oxygen.
Seek medical attention if symptoms develop.
Do NOT induce vomiting unless directed to do so by medical personnel. Never
give anything by mouth to an unconscious person. If large quantities of this
material are swallowed, call a physician immediately. Give plenty of water.
FIRE FIGHTING MEASURES
Fire Hazard Classification (OSHAINFPA):
Extinguishing Media:
Special Fire Fighting Procedures:
Hazardous combustion products:
0
As required for fire being fought.
Use self-contained breathing apparatus.
No known.

ENVIRCOPCLAN
SECTION 6 ACCIDENTAL RELEASE MEASURES
Personal Precautions, PPE, and Emergency Procedures:
Wear protective clothing as described in Section 8 of this safety data sheet.
Containment Procedures: Stop the flow of material, if this is without risk. Wear appropriate protective
equipment and clothing during clean-up. Do not allow the spilled product to enter
public drainage system or open water courses.
Clean -Up Procedures:
Sweep up or gather material and place in appropriate container for disposal.
Wash spill area thoroughly. Wear appropriate protective equipment during
cleanup. Dispose of collected material according to regulations.
SECTION 7 HANDLING AND STORAGE
Handling:
Storage:
Avoid contact with eyes, skin and clothing. Do not take internally. For industrial
use only. Wash after handling. Don't breathe dust, vapor, or gas. Keep this and
all chemicals out of reach of children.
Keep away from heat, sparks, and open flames. Prevent spills. Keep container
tightly closed and in a cool, well -ventilated place away from incompatible
materials. Empty product containers may contain product residue, do not reuse.
SECTION 8 PERSONAL PROTECTION / EXPOSURE CONTROLS
Ventilation System: Always keep exposure below permissible exposure limits. In general, dilution
ventilation is a satisfactory health hazard control for this substance. However, if
conditions of use create discomfort to the worker, a local exhaust system should
be considered.
Airborne Exposure Limits: None Established.
Personal Protection: As prescribed in the OSHA Standard for Personal Protective Equipment (29 CFR
1920.132), employers must perform a Hazard Assessment of all workplaces to
determine the need for, and selection of, proper protective equipment for each
task performed.
Eyes: Wear face shield, safety glasses, or chemical goggles.
Hands & Skin; For prolonged or repeated handling, use impervious gloves. Gloves should be
tested to determine suitability for prolonged contact. Use of impervious apron
and boots are recommended.
Respiratory: If ventilation is not sufficient appropriate NIOSHIMSHA respiratory protection
must be provided.
Work Practices: Eye wash fountain and emergency showers are recommended.
SECTION 9 TYPICAL PHYSICAL AND CHEMICAL PROPERTIES
Physical Form: Liquid
Color: Red

ENVUR LEA N
Odor:
Odor Threshold:
pH:
Boiling Point:
Melting Point:
Flash Point:
Evaporation Rate (Butylacetate = 1)
Flammability:
UEL:
LEL:
Vapor Pressure:
Vapor Density:
Specific Gravity (Water = 1):
Solubility Water:
Partition Coefficient:
Auto -ignition Temperature:
Decomposition Temperature:
Viscosity (CPS):
SECTION 10
Wintergreen
NE
8.5+1-0.5
NE
N/A
>200 deg F
NE
Non -Flammable
NE
NE
NE
NE
1.03 +1- .05
Complete
NE
NE
NE
NE
STABILITY AND REACTIVITY
Stability:
Incompatibility:
Decomposition Products:
Conditions to Avoid:
SECTION 11
This product is stable under normal temperatures and pressures.
Strong Oxidizers and strong acids.
No Known hazardous products.
Sparks/flames/high heat.
TOXICOLOGICAL PROPERTIES
Raw Material
Test
Result
Route Species _
N/A
See Section 4 for symptoms.
CARCINOGENICITY:
No known carcinogens, mutagens, or reproductively toxic ingredients
SECTION 12
ECOLOGICAL INFORMATION
Raw Material
Test
Result
Time
Species
N/A
PERSISTENCE & DEGRADABILITY:
NE

ENVIR~~~
BIOACCUMULATION:
NE
MOBILITY
NE
SECTION13 DISPOSAL CONSIDERATIONS
Whatever cannot be saved for recovery or recycling should be managed in an appropriate and approved
waste disposal facility. Processing, use, or contamination of this product may change the waste
management options. State and local disposal regulations may differ from federal disposal regulations.
Dispose container and unused contents in accordance with federal, state, and local requirements.
SECTION 14 TRANSPORT INFORMATION
Not Regulated by DOT or IATA.
SECTION 15 REGULATORY INFORMATION
US FEDERAL REGULATIONS
SARA (SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT):
SARA 302 EXTREMELY HAZARDOUS SUBSTANCES LIST: NA
SARA 312 HAZARD CATEGORY: NA
SARA 313 TOXIC CHEMICALS LIST: NA
CERCLA (COMPREHENSIVE ENVIRONMENTAL RESPONSE. COMPENSATION AND
LIABILITY ACT): NA
RCRA (RESOURCE CONSERVATION AND RECOVERY ACT) LISTED HAZARDOUS WASTES:
NA
CWA (CLEAN WATER ACT) LISTED SUBSTANCES: NA
FDA (FOOD AND DRUG ADMINISTRATION): NA
TOXIC SUBSTANCES CONTROL ACT (TSCA): NA
IATA: NA
ENVIRO CLEAN
NFPA HAZARD INFORMATION SIGN
[0]
[0]
4 - DEADLY
3 - EXTREME DANGER
2 --- HAZARDOUS
1 - SLIGHTLY HAZARDOUS
0 -NORMAL MATERIAL
FLASH POINTS:
4 - BELOW 73 F
3 - BELOW 100 F
2 - BELOW 200 F
1 - ABOVE 200 F
0 WILL NOT BURN
[0] REACTIVITY HAZARD (YELLOW DIAMOND)
4 - MAY DETONATE
3 -- SHOCK AND HEAT MAY DETONATE
2 - VIOLENT CHEMICAL CHANGE
1- UNSTABLE IF HEATED
0 - STABLE
i] SPECIFIC HAZARD (WHITE DIAMOND)
OXY OXIDIZER
ACID ACID
ALK ALKALI
COR CORROSIVE
W USE NO WATER
SECTION 16 OTHER INFORMATION
THIS INFORMATION IS OFFERED IN GOOD FAITH AS TYPICAL VALUES AND NOT AS A
PRODUCT SPECIFICATION. NO WARRANTY, EXPRESSED OR IMPLIED, IS HEREBY MADE. THE
RECOMMENDED INDUSTRIAL HYGIENE AND SAFE HANDLING PROCEDURES ARE BELIEVED
TO BE GENERALLY APPLICABLE. HOWEVER, EACH USER SHOULD REVIEW THESE
RECOMMENDATIONS IN THE SPECIFIC CONTEXT OF THE INTENDED USE AND DETERMINE
WHETHER THEY ARE APPROPRIATE.

ATTACHMENT C
WELL CONSTRUCTION RECORDS
(SECTION K)
WELL CONSTRUCTION RECORD
North Carolina - Department of Environment and Natural Resources - Division of Water Quality - Groundwater Section
WELL CONTRACTOR (ILNDIVIDUAL) NAME (print) DAV ID WATE S
WELL CONTRACTOR COMPANY NAME PARRATT-WOLFF , =NC .
STATE WELL CONSTRUCTION PETiMIT# ❑ 5 2 '4 — .-tIb►$ ^.etva sS-OCL.TED WQ Pi~170417
(if applicable) if applicable)
CERTIFICA.TIGN # 2 9 9 9
rlaoNE a 1—644-28I4
1. WELL USE (Check Applicable Box): Residential 0 Municipal/P'.:Ciic CI Industrial 0 Agricultural 0
Monitoring El Recovery 0 Hear Pump Water Injection 0 Other 0 If Other, List Use-
2. WELL LOCATION:
Nearest Town: GREENSBORO County GUILFORD
EAST WENDDVER AVENUE
Street Name, Numbers, Community, Subdivision, Lot No., Zip Cade)
3. OWNER: 4f/4c4y6-35; "C
Address 54'b'G u v► tretri
(Sheer or Rowe C No.)
1Jy IN3re + r� L4�+j
City or Town State Ztp Cede
(334). 76 7- - czg�
Area code, Phone number
4. DATE DRILLED 10/8 / 01
S. TOTAL DEPTH: 3 0 . 0 '
6. DOES WELL REPLACE EXISTING WELL? YES 0 NO
7, STATIC WATER LEVEL Below Top of Casing: 7. I Y FT
(Use "+" if Above Top of Casing)
8. TOP OF CASINO IS FT. Above Land Surface'
2 t/oc
'Top of casing gleaned otter blow load surface require, e
variance in accordance with 15A NCAC 2C .Olt&
4. YIELD (gpm): • METHOD OF TEST
10, WATER ZONES (depth):
LOCATION SKETCH
Show direction and distance in miles from at least
-xo State Roads or County Roads. Include the road
nanbers and common road names.
Topographic/Larid setting
,Ridge ❑Slope OValley CiFlat
(check appropriate 'box j
Latitude/longitude of well location
(degreesr minuteslseconds )
Lanmde/ioag.tudde soi:rce:OG?SOTopographic map
(obock box)
DES DRILLING LING LOG
From To Formation Description
3. 5 / eittW.d l6►0-4- iin y L4i
IT.5' .a' Gregr reAldr 5iL.7-
13, 5' f 5! _ _ _ _ Pr'c, r3Rgwv_C-4WAY
.5' daf pk, gpiwe r4747Y cletr
ZD
30i J%tTM'u-Y- A/t', v
iloc
11. DISINFECTION: Type
12. CASING:
Depth
From 0 To 10
Ft.
From To Ft
From To Ft. _.
I3. GROUT: Depth Materiel Method
From 0 To 2 Ft. PORTLAND TREMIE
From 2 To 8 Ft.HENTONTITE TREMIE
Diameter
2"
Amount
Wait Thickness
or Weight/Ft, Materia!
SCH40 PVC
14, SCREEN: Depth Diameter Slot Size Material
From 10 To 3 0 Ft. 2 in. .010 in. P V C
From To Ft. in.
15. SAND/GRAVEL PACK:
Depth Size Material
From 8 To 30 Ft, *1 SAND
From To Ft.
MW—I
Please see Drawing 1 , 1
of this report.
16. REMARKS:
l DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRIIC rED IN ACCORDANCE WITH 1 SA NCAC 2C, WELL
C TRUCT --4-TAmp S, ANT) THAT A COPY OF THIS RECORD HAS BEEN PROVIDED TO THE WELL 0
C /SI0/
SIGNATURE OF PERSON CONSTRUCTING THE WELL )A'F'E
Submit the original to the Division of Water Quality, Groundwater Section, 1636 Mall Service Center - Raleigh, NC
27699-1636 Phone No. [phone], within 30 days. GW-1 REV. 07/2001

ODE TH
f P
i '10 x.
bES-C,P,.11.
0.0 - 1.0
Asphalt/Crush and Run
3.5 - 5.0
Brown/Gray Sandy Silt
8.5 - 10.0
Gray Sandy Silt
13.5 - 15.0
Dark Brown Sandy Clay
18.5 - 20.0
Dark Brown Sandy Clay
20.0 - 30.0
Partially -Weathered Rock
Boring terminated at 30.0 feet BLS.
REMARKS: Boring advanced with
hollowstem augers to 30 feet BLS.
Type Il Monitoring Well Installed Upon
Boring Completion.
.:t,,k:: 7ES`T B6R1I� ._� G G�,;
=, = ;;
BORING NUMBER: MW-1
DATE DRILLED: 10/08/01
PROJECT NUMBER: 000R1143.01
PROJECT: WILCO #302
PAGE 1 OF 1
AT Al11 I S OCIA.:iti iN
;'E► g n e rn F. i ira iiireritaiSiih t pt

F,I�LM'1 : CARLIL 1 NH5
I-'HUNk Mu. 644 InEd eE, r 5l=_p. I4�:.StNM P4
WELL CONSTRUCTION RECORD/14(
- r
North Carolina - Department EroArensnern and Natural Rea Cameo • DI isirn of water Qualr'ty - GrumWinker Sealicrs
WSJ. cot RACToR (NDIVID L) NasaRg
wag. CONiRAC IVR COMPANY NAME
STATE Wak. CoNBTRUCTiQN PEW Mt
{iT a anomie&
1. WELL USE (Chock Appl+oeble Box):
Manioring _X. Recovery
2. WELL LOCATION: (Shaw skrdtlah of the l000don bets
Nearest Town: Greensboro Count Guilford
20O5 E, Waredlaler Arr3
Ohio. oem„Mrbi er t5atcHoko++saLo ARM
3, OWNER: Wilco#St2
MDRESS: YO¢5 E. Werr44►€ A►8
Rand- Pnflrm
Si rYa orHti +i CERTIFICATiONr1
tOA * .744) -0773
ASSOCIATED WO ;MIN
(tt apoGable0
ami
Rassdeiltiai Maniepaypihire Industrial Anneullunai
Heat Pump Water Inicodorr „— aQre+r rrather list use
Tepagraphirs1/1-and Setting
Rlogo — swim VaElay TPlot
Lardrudeienigurcra
SIAM Gr Bt a rrlaw rw,} ex a ar %ow. c37a t+pare Soll�s
cover Taw Cate �Cadn t}CzP17 f NC
DRI1.0 G toa
Ftwrs To Foflmeon paascrietbn
A.
Gab. Pr►+rrr samba
4. DATE DRILLED! Mfg
5, TOTAL DEPTH: at
/. ROES WELL REPLACE EXISTING WELL?
8STATIC WATER LEVEL Sok*v- Top of Coming:
No
rt
Me 'toff abut. /W it/r A+w1
9. TOP OF CASING I5 0 FT, A1,+are Land Surface
Ca Ike Twrraven6 rdpr oaavar YnC Reece is lima Am a mime* 4
*Am) l sam rd+rr.s tit' I &A µC.*o zrz as in
10. YIE D (Opm)-
11, WATER ZONRE (depth):
12. CHLORINATION Type:
13, CASING:
ME11.10 7 OF TEST:
Well Thidrrress}
If sllddlleoed same w needed ate rack of term
Death Diornater or Weight/FL Material
Fr= 0 To 5 Ft_ 2" soh 40 PVC 1-Pc-fa$.07CH
RCM To Ft. (showdsreaier oral dim raa Imre * telaftro EXErLO
From To Ft- _ . Reeds. a ethar+rsep reEoranc+e I rr+al
14, GROUT;
Depth Material Meths]
Frtxn 0 To 1 Ft, 6eotnniielOenent Pour
Frorfl 1 To . 3 FF Jantorrite ... —.... Pour
15. SCREEN:
Depth Diameter " S lot Sire " Material
Fern 5 To 25 F L 2" .010 PVC
From To Ft,
From To Ft.
10. SAND/GRAVEL PACK:
❑epth Size Material
From 3 TO 25 Fi. 112 Sand
Fran To FL
16. REMARKS, MYY 7
HWY 29
I DO HERIZEIY CERT FY THAT WEIL WAS CONSTRUCTED IN ACCORDANCE WIYti SSA CAC 2C, WF_u. CORsTRIX RoN
, AO ORtr rw3 6aR+ PRQ'NlaIED iC'!HE W®ki. oVVNER
11,,M LafprR54seccH.97RutriNo tea,
D1

DEPTH
(FEET}°.
PEs F I r0N `
NO SOIL CLASSIFICATION
Boring terminated at 25.0 feet BLS.
REMARKS: Boring advanced with
hollowstem augers to 25 feet BLS.
Type II Monitoring Well Installed Upon
Boring Completion.
BdRINGL�
BORING NUMBER: MW-7
DATE DRILLED: 7127/02
PROJECT NUMBER: 000R1143.O1
PROJECT: WILCO #302
PAGE 1 OF 1
PA„ 1'--)1S f�lrl►�
np ieeiin4 $i' E-inW airiii taQ54
T

LEGEND
—x
ASPHALT
PARKING
MW-10
S
MW-1 MONITORING WELL LOCATION
MW-3i INTERMEDIATE MONITORING WELL LOCATION
s VE-1 VACUUM WELL LOCATION
i LIGHT POLE
-0- UTILITY POLE
WATER METER
® SANITARY SEWER MANHOLE COVER
FENCE
PROPERTY BOUNDARY
SUBJECT SITE PROPERTY BOUNDARY
(FP) FREE PRODUCT IN WELL
(ND) NOT DETECTED
(NS) NO SAMPLE COLLECTED FROM WELL
(9,240) BENZENE CONCENTRATION AT LOCATION ug/L
ESTIMATED BENZENE ISOCONCENTRATION CONTOUR FOR THE
THE N.C. GROSS CONTAMINANT LEVEL ug/L
— — -- —1❑ ESTIMATED BENZENE ISOCONCENTRATION CONTOUR ug/L
.11 MEM
—.1.0
ESTIMATED BENZENE ISOCONCENTRATION CONTOUR FOR THE
NC GROUNDWATER QUALITY STANDARD ug/L
WATER V�iLVE
f �"Q
iaMW-16 rc
,I KEROSENE DU
DUMPSTER jf�J PADS P r_1
_ J
M(40
ND)
TAW-_
(2,1I0
/ (ABAND���yy _gg
/ ONED)
is
MW-7 Op)
-; 501 DUST
ES +
BUS ND L- J!
JUNCTION CANOPY N.
VAULT-L
W- 31 MW-20
(7,430)
EAST 1f7P A►g (*-372701510
GRASS MEDIAN
?� /•
•
TAW-11
(NS)
FJ�TE:
MW-31 IS A TYPE III WELL AND WAS NOT USED IN
GENERATION OF CONTOURS
FREE PRODUCT DETECTED IN JAW-7; HISTORICAL RESULTS
WERE USED FOR WELLS MW-4, 5, 6, 7, 10, 11. 12 IN GENERATING THE ISOCONTOURS.
0
r
ADJACENT
0LilLD1NC
O
SCALE: 1 `= 40'
40'
DECEMBER 2016
JOB NO: O00R1143.28
CAD # 01-114303-27
z
itJ
z
3
0m
0
lnF-
Lii
CC
LdJ
cc
z
Q <
d
OJ r Z Z
¢w=LLI
zma
[I7 � "J OC
Zbi )O
CD
LU Cr)
Z U) LLIJ
NJ CINJ cc
Z
C.4 CD
IJJ
m
REFERENCE: ROBERT E. WILSON,

LEGEND
ASPHALT
PARKING
(AIM
MONITORING WELL LOCATION
INTERMEDIATE MONITORING WELL LOCATION
LIGHT POLE
UTILTIY POLE
WATER METER
SANFTARY SEWER MANHOLE COVER
FENCE
PROPERTY BOUNDARY
SUBJECT SITE PROPERTY BOUNDARY
(FP) FREE PRODUCT IN WELL
(NM) NOT MEASURED
(772.89') WATER TABLE ELEVATION AT LOCATION (FT-MSL)
ESTIMATED GROUNDWATER FLOW DIRECTION
772.5' ESTIMATED WATER TABLE CONTOUR (FT-MSL)
ZMW-12
(NM)
(ABAN-9
DONED)
1
I
' f WATER VALVE
Q + wv
&MW-16 r,�.���—x~
ik,EROSEN 1rDL1PADDT£R UST
8�
0.91)
772.0
0772.5
& MW-1
(772.6
--2
2.5
CONCRETE
(BMW -1 1
(NM)
PSW
•
DISPENSERS
Ed
i
ADJACENT
BUILDING
0 40'
SCALE: 1'- 40'
❑ECEMBER 2D16
0
JOB NO: 000R1143,28
CAD # 01 -1 1 4305-27
D
z
0
0
LV
z
0
z
am
0
w
0
a
m
ESTIMATED WATER TABLE
•
INC. SURVEY MAP DATED 2/23/04.
z
0
(1)
I--
ce
Li1
QS
0
U
z
Lu
Li
Lv
iY

7
LEGEND
e MW-2 SOIL BORING INSTALLED USING DRILL RIG
• SB--1 501L BCR 1NG INSTALLED USING GEOPROBE
*GP-i SOIL BORING INSTALLED USING G£OPAOBE
GW-2 SOIL BORING INSTALLED USING GEOPRCBIE
LIGHT POLE
-0- UTILITY POLE
WATER MEIER
SANITARY SEWER MANHOLE COVER
FENCE
-- — PROPERLY BOUNDARY
A - A' CROSS-SECTION LOCATION
eGW-2
,P-1
JUNCTION
VAULT
• CP-2
* GP-3
WATER VALVE
1
A'
EAST HEWOOPER A'E7'JE
DU
IZTER
CP--B
GASOUN
usr&
GP-4
1KER05EItlq{
5H-8
• s9-5
B0
DI L -1r se-s
L-- -
GP-7
r 53-4
x M x
. a.
987
WILCO
STORE
MW-1 to MW- i
G 30'
SCALD 1 3O'
JUNE 2004
000R 1143.03
O
m
# 01-114306-03
he
8
z
m
s
LJ
11]
cj
1.0
6
*61
REFERENCE: ROBERT E. WILSON, INC. SURVEY MAP DATED 2/23/04.