WI0400479_DEEMED FILES_20180130

Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0400479
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Forest Oaks Circle K
Location Address
5324 Liberty Rd
Greensboro
Owner
Owner Name
NC 27406
Ncdeq Dwm Ust Section-Federal & Stsate Lead Program
Dates/Events
Orig Issue
1/30/2018
App Received
1/22/2018
Reg ulated Activities
Groundwater remediation
Outfall
Waterbody Name
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
1/30/2018
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Afflllatlon
Major/Minor
Minor
Region
Winston-Salem
Facility Contact Affiliatlon
Owner Type
Government -State
Owner Affiliatlon
Mark Petermann
1646 Mail Service Ctr
Raleigh
County
Guilford
NC
Issue
1/30/2018
Effective
1/30/2018
27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOJ) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule" and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200. This torm shall be submitted at least 2 WEEKSJrrior to injection.
AQUIFER TEST WELLS tt5A NCAC 02C.02201
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
I}V SITU REMEDIATION 05A i`CAC 02C 1225) or TRACER WELLS t isA reAc t12C .02291:
1) Passive Iniection 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 Operations — Injection wells located within a land surface area not to exceed 10,000
square feet for the purpose of soil or groundwater remediation or tracer tests. An individual permit shall be required
for test or treatment areas exceeding 10,000 square feet
3) Pilot Tests = Preliminary studies conducted for the purpose of evaluating the technical feasibility of a
remediation strategy in order to develop a full scale remediation plan for future implementation. and where the
surface area of the injection zone wells are located within an area that does not exceed five percent of the land
surface above the known extent of groundwater contamination. An individual permit shall be required to conduct
more than one pilot test on any separate groundwater contaminant plume.
4) Air Injection Wells - Used to inject ambient air to enhance in -situ treatment of soil or groundwater.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete
DATE: 2 1 .20
PERMIT NO. n. E C 0 441 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
_ Cr'
(1) Air Injection Well Complete sections B through F, K,� rn
(2) Aquifer Test Well .Complete sections B through F, K, 0 n_ t.z.
t C7
(3) Passive Injection System Complete sections B through F, H-1►
(4) XXXX Small -Scale Injection Operation. Complete sections B through N
(5) Pilot Test Complete sections B through N
(6) Tracer Injection Well Complete sections B through N
B. STATUS OF WELL OWNER: Choose an item.
C.
WELL OWNER(S) — State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the business or agency:
Name(s): NCDEU. DWM, UST Section -Federal & State Lead Program tTF# 32981
Mailing Address: 1646 Mail Service Center
City: Raleigh State: NC Zip Code: 27699-1646 County: WAKE
Day Tele No.: 919-707-8166 Cell No.:
EMAIL Address: Sharon.Ghiold urncdeur.uov Fax No.: 919-571-4718
Deemed Permitted GW Remadiation NOI Rev. 611 no 17 Page I

D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: --~No..:..::ar:..:a:::cs~im"'"h"'a~R=:..... Y..o....:cen'""i:..:ae.-=an""d::.:l=a.'-'P'-'r""o""p-=-e':...:.1Y,<.....;:O:;..:w..:...:nca.:eca.r ______________ _
Company Name ---""'Su~nr=is""e'-'F'-'o=o=d:....G=as=·=L=L=C"---------------------------
Mailing Address: -----=5-=--07_,______,_W,....,.--=3'---rd_,S=tr=e=e-=--t ________________ _
City: Siler City State: NC Zip Code:--=2"-'-7=-34_,_4,__ ___ County: CHA THAM
Day Tele No.: 919-742-6003 Cell No.: NIA
EMAIL Address: __ __,,a,N"'"/"-'A'------------Fax No.: NIA
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: --~K=ev..:...:in=-=B=u=c=h=an=an==-------------------------
Company Name ---~W~i=th=e=rs=R=a=v--=e=ne=I"-. =In=c~·-----------------------
Mailing Address: --~l--=1=5--=M=ac=K=e=n=an=-=D~r=iv~e~----------------------
City: Cary State: NC Zip Code:._=2~75~1~1 ____ County: WAKE
Day Tele No.: 919-469-3340 Cell No.: __ ~9~1~9_-4_2_2-_1_14_1 ___ _
EMAIL Address: kbuchanan@ withersravenel.com Fax No.: --~9_1~9-_4_67_-_6_00_8 ___ _
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: -------"'-F_,,o.,_,re=s-=--t =O=a=k"--s =C=ir=c=le,_,K,_,,__ _______________ _
5324 Liberty Road
City: ___ G_r_e_e_ns_b_o_ro ________ County: Guilford Zip Code: =27~4=0-=-6 __ _
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or 0
Longitude**: 0 __ "or 0
Reference Datum: ________ .Accuracy: ________ _
Method of Collection: __________________ _
**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: "" 14 ,000 (Est) square feet
Land surface area ofinj. well network: < 1.000 square feet~ 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: :::el0% (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
(2) Cross-section(s) to the known or projected depth of contamination that show the horizontal and vertical
extent of the contaminant plume in soil and groundwater, changes in lithology, existing and proposed
monitoring wells, and existing and proposed injection wells.
(3) Potentiometric surface map(s) indicating the rate and direction of groundwater movement, plus existing
and proposed wells.
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page2
I. DESCRIPTION OF PROPOSED INJECTION ACTIVITIES -Provide a brief narrative regarding the
purpose, scope, and goals of the proposed injection activity. This should include the rate, volume, and duration
of injection over time.
Pu rp ose: Reduction of Gross Contaminant Level concentrations of petroleum com pounds.
Sco pe: In jection of EnviroClean surfactant into one existin g 2" diameter monitorin g well followed by the
performance ofa surfactant enhanced recove rv event (A gg ressive Fluid/Va por Recove ry).
Goals: Reduction of source area contamination throu gh removal of dissolved-phase petroleum contamination
with the aid of surfactants.
J. APPROVED INJECT ANTS -Provide a MSDS for each injectant. Attach additional sheets if necessary.
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved injectants can be found on/ine at htt p://deg.nc.2.ov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-water-protection/ground-water-a pproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the VIC Program for more info (919-
807-6496).
Injectant: --""E=nv_,_w=· o=C=le=a=n'---'S=u=r£=a=c=ta=n=t ______________________ _
Volume of injectant: __ 7.,_6"""'1'--=G=a=ll=o=n=--s .,_(1"--'5'-'='ga=l=lo=n=s"-'E=n=v'"'ir""o=-C=l=e=an=-=d=il=u=te=-=d=-w"-'-=it=h-'w""a=t=er=-t=o=-5=--0.,_1/o=-s=o=-=l=ut=i=on=).___
Concentration at point of injection: ---'5=-o/c'"'o"'"'M=ix=tur=e=-w"""""it=h""p"'o"""t=ab=l=e-'w-'-a=t=er=------------
Percent if in a mixture with other injectants: 5% EnviroClean. 95% potable water
Injectant: ----------------------------------
Volume of injectant: _____________________________ _
Concentration at point of injection: _______________________ _
Percent if in a mixture with other injectants:
K. WELL CONSTRUCTION DATA
(1)
(2)
Number of injection wells: ___ O ___ Proposed ___ l ___ Existing (provide GW-1 s)
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
Well Contractor Name: NIA NC Certification #: __ N~/ A~_
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Followine approval. schedule includes:
1. Gaucine of site monitoring wells (Da\ 11.
2. Performance of apre-injection AFVR event iDa‘ 1)
3. Injection of surfactant into wells t Da\ s 1/2)
4. Performance of a host -injection AFVR event t Week 21
5. Performance of a site -wide groundwater eautzirn2 and monitorin.1 event i Week 5
M. MONITORING PLAN — Describe below or in separate attachment a monitoring plan to be used to determine
if violations of groundwater quality standards specified in Subchapter 021. result flout the injection activity.
After completion of injection and post -infection AFVR event at the facilir) . WR proposes a groundwater
sampling event at the site after three -weeks' time to determine whether: al the injection of material has had the
desired effect (c.2.. reduction of petroleum contaminants in eroundwater of the site).
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty oflaw, that !am familiar with the information submitted in this
document and all attachments thereto and that, based on my inquiry of those individuals immediately responsible
for obtaining said information, 1 believe that the information is true, accurate and complete. I am aware that
there are significant penalties, including the possibility of fines and imprisonment, for submitting false
information. I agree to construct, operate, maintain, repair, and if applicable, abandon the injection well and
all related appurtenances in accordance with the I,5A NCAC 02C 0200 Rules."
Signature of Applicant
Mark Brown. LG. RSM. on behalf ofNCDEQ-DWM. UST Section,TF#3298
Print or Type Full Name and Title
PROPERTY OWNER (if the property is not owned by the permit applicant):
"As owner of the property on which the injection well(s) are to be constructed and operated, J hereby consent to
allow the applicant to construct each injection well as outlined in this application and agree that it shall be the
responsibility of the applicant to ensure that the injection well(s) conform to the Well Construction Standards
5A WL'4 102C.G200)."
"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.
SEE ATTACHED NCDEO STATE -LEAD ACCESS AGREEMENT FOR PROPERTY
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner maybe submitted in lieu of a signature an this form.
Submit the completed notification package to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NO1 Rev, 6/1/2017 Page 4

Waste Management
EµV{ElONMENYAL QVALITY
Certified Milt 7017 0190 0000 1632 0162
December 19, 2017
Sunrise Food Gas, LLC
507 W St
Siler City, NC 27344
RE: Access Request
Former Forest Oaks Circle K
5324 Liberty Road
Greensboro, Guilford County, NC (WSRO)
WS-2436, STF Incident Number 3298
Risk/Rank: High,11205D
Dear Property Owner:
ROY COOPER
Governor
MICHAEL 5. REGAN
Secretory
MICHAEL SCOTT
Director
In 2007, the Winston Salem Regional Office (WSRO) referred the subject site to the State Underground Storage
Tank (UST) Trust Fund Branch, State -Lead Program for inclusion on the list of sites awaiting cleanup. On July
30, 1992, soil contamination was detected. from USTs at this site during an initial site assessment. Tree product
was also observed in the tank basin during tank removal activities in 1993. Due to the presence of groundwater
users within 1500 feet of the site and based on the confirmation of contamination remaining at the site, the subject
property was accepted by the State for inclusion to the list of sites for State -Lead cleanup- According to the
information on file, you are not considered to be an owner or operator of the former USTs pursuant to G.S. 143-
215.94A.
In order to continue working at the site, the UST Section will need to access your property in order to take all
reasonable and necessary action(s) to conduct assessment and remedial activities necessary to protect human
health and the environment. Please sign the attached site access agreement Letter and return to the address
indicated on the letter. Please understand that failure to allow access to the property could potentially make you
responsible for the cleanup under other State and Federal regulations. You will be notified when assessment
and/or remedial activities begin. If you have any questions, please contact me at [phone] or
sh aro n. ghi o1 d @n cd.enr.gov.
Thank you,
ciPzzedi
Sharon Ghiold, Hydrogeologist
Division of Waste Management, NCDEQ
Enclosure
Stale of North Carolina I Envlmnreenf al Quality I Waste Management
2E7 West Jaws Street { 1646 Mail Service Center I Raleigh, North Carvfrw 2T649-1646
919107 6200

Sharon Ghiold
DWM UST Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Dear Ms. Ghiold:
RE: Site Access Agreement
5324 Liberty Road
Greensboro, Guilford County, NC (WSRO)
Incident Number 3298
Risk/Rank: High, H205D
I am/We are the owner( s) of a parcel of property, located at or near the incident in question,
and hereby permit the Department of Environmental Quality (Department) or its contractor to enter
upon said property for the purpose of conducting an investigation of the groundwaters under the
authority of G.S. 143-215.3(a)2.
I am/We are granting permission with the understanding that:
1. The investigation shall be conducted by the UST Section of the Department's Division ofW aste
Management or its contractor.
2. The costs of construction and maintenance of the site and access shall be home by the
Department or its contractor. The Department or its contractor shall protect and prevent damage
to the surrounding lands.
3. Unless otherwise agreed, the Department or its contractor shall have access to the site by the
shortest feasible route to the nearest public road. The Department or its contractor may enter
upon the land at reasonable times and have full right of access during the period of the
investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article
31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State
Departments and Agencies, and as otherwise provided by law.
5. The information derived from the investigation shall be made available to the owner upon
request and is a public record, in accordance with G.S. 132-1.
6. The activities to be carried out by the Department or its contractor are for the primary benefit
of the Department and of the State of North Carolina. Any benefits accruing to the owner are
incidental. The Department or its contractor is not and shall not be construed to be an agent,
employee, or contractor of the land owner.
Forest Oaks Circle K
STF #3298
Page 2
1/We agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
Signature
S\ 6Z'�
T e/Print Name of Owner or Agent
Type/Print
Phone Number
V(g CZ9
Address
City/State/Zip Code
Email

■O- WithersRavenel
r:Ii leers tic;;,, : j a�>, ;c•=_
Sit •ale
FOREST OAKS CIRCLE K
INCIDENT # 3298
hn4 1.16F.BSY WOAI.1
GREEN O O G111LFVkDL.OLIN1Y,ry'
GENERAL LOCATION MAP
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12/11 17
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NUN RESIDENTIAL van., CONSTRUCTION RECORD
North Ce oiina Department of -Environment and Natural Resources- Division of Water Quality
WEIL CONTRACTOR CERTIFICATION #
1. WELL CONTRACTOR:
Thomas Whitehead
Well Contractor (Individual) Name
S&ME. Inc.
WON Contracter Company Name
3201 Sorina Forest Road
Street Address
Raleigh NC 27616
City or Town Slate Zip Code
[phone]
Area code Phone number
2_ WELL INFORMAT1ON:
WELL CONSTRUCTION PERMIT# MW-5
OTHER ASSOCIATED PERM nvaapprrcable}_
SITE WELL ID*Or s OW:0)
3. WELL USE (Check Cne Box) Momtoting t1eMrmieipallPublie O
InduetrralfCanim tcial ❑ Agricultural ❑ Recovery(3 Injection ID
Irrigation❑ Other ❑ (list use)
DATE DRILLED 5/15/12
4, WELL LOCATION:
1304
tslreet Name. Numbers. Coin unky, Suodrvwion, Lot No. Parcel, 21i Code)
crrV: Greensboro couNTYGuilford
TOPOGRAPHIC: LAND SETTING: (check appropriate boll
❑S10P8 ❑Valtay t ❑Ridge Oother
LATITUDE 36 " DMS DR 3x.xaocaotx7oc no
LONGITUDE 75 • DMS OR Tx.Y.]OCOCOo0C U
Latkudefonghudn source: I BPS QTopographic mop
{iocaRort of welt must be shown on a USGS top° wrap endettached !a
this farm 1f not using GPS)
5. FACILITY (Name of the business whore the well rs tocatod-)
F9res#S7ak Circle K
Fae
Street Address
nreent,bona NC
City or Town State Zip Code
SharoQ nbioid - MCnFNf2_nWM
Contact Herne
1637 Mail Service Center
Facility ID* (rf applicable))
Mal7ing Address
Raieiah rid: _27649
City or Town State Zip Cade
Area code Phone number
E. WELL DETAILS:
e. TOTAL DEPTH: 16'
b. DOES WELL REPLACE EXISTING WELL? YES ❑ NO iV
c, WATER LEVEL Below Top of Casing N/A FT.
(Use'+" tfAbove Top of Casing)
2907
d. TOP OF CASING IS 0.0 FT. Above Land Surface'
Top of Casing terminated atfor below land surface may require
a variance in accordance with 1SA NCAC 2C .0118
e. YIELD (gpm): METHOD OF TEST
f. DISINFECTION: Type Amount
g. WATER ZONES (depth):
Top
Top
Top
Bottom Top Bottom
Bottom Top Bottom
Bottom ___ _ _ Tap Bottom
Thickness/
7. CASING: Depth Diameter Weight Material
Top 0 Bottom 6 Ft. 2" _sch40 PVC
Top Bottom FL
Top Bottom Ft. -
E. GROUT: Depth Material
Top 0 Bottom, 4 FL cenjent arout
Method
pour
Top 4 Bottom 6 Ft. bentonite oour
Top, Botorn_ Ft.
e. SCREEN: Depth Diameter Slot Size Material
Top 6 Bottom 16' Ft, 2 in. Q10 in PVC
Top Bottom Ft. in. In.
Top Bottom Ft In. in.
10. SAND/GRAVEL PACK:
Depth Size Material
Tap ` Bottom 16 FL #2 Sand
Top Bottom Ft _ -
Top Bottom Ft.
11. DRILLING LOG
Top Bottom Formation Description
o 1 5
5 1 8
8 / 12
12 1 16
1
1
1
1
1
1 _
12. RE1t7ARKS:
Blown Sandy Clay
Brown silty Sand
Brown Clay
Orange to Brown Slit
100 HEREBY CERTrFYTHAT THIS WELL WAS CONISTRIXIED ArccianamcE WITH
1"SA MAC 20, WELL OONSTRuCrIDH SCANDAL MIDWAY ACOPY OFTiiS
HAS VE'EN PRWID> THEWELLOARAR
r_ ._
SIGNATURE OF CERTIFIED WELL CONTRACTOR TE
Thomas Whitehead
PRINTED NAME OF PERSON CONSTRUCTING THE WELL
Submit within 30 days of completion to: Division of Water Quality - information processing,
1617 Mafi Service Center, Raleigh, NC 27SE -1I1, Phone : (81 )10T-300
Form GW-1 b
Rev. 2109

COMPLETION REPORT OF WELL No. MW.-2 Sheet 1 of 1
PROJECT: Forest Oaks Circle K
PROJECT NO: 1354-09-167A
PROJECT LOCATION: Greensboro,· Ne
DRILLING CONTRACTOR: Brown Environmental
DRILLING METHOD: Auger
DATE DRILLED: 11/3/09
STRATA WELL i!: .... .J
0 :::c: DETAILS fu~ DESCRIPTION m ti:~ ~ 0 >-w!:..
en 0
0 0.0D
asphalt pavement -
15ystem
tan brown Sandy
Clayey SILT
Gray Green Clayey
SILT
5
Gray Course to Fine·
Sandy SILT
-10
Dense Gray Silty Sand
Gray Silty Sand
-15
0 z w
(.!) w
.J
GS
WATER LEVEL:
LATITUDE:
LONGITUDE:
TOP OF CASING ELEVATION: 834.98
DATUM: MSL
LOGGED BY: W.Watterson
z
0 r:: .... ~~ WELL CONSTRUCTION DETAILS
w
.J w
PROTECTIVE CASING
Diameter:
Type: Manhole Cover
Interval:
RISER CASING
Diameter: 2inches
Type: PVC
Interval: 0.2-7
GROUT
Type: Neat Cement
Interval: 0-3
SEAL
Type: Bentonite
Interval: 3-5
FILTERPACK
COMPLETI ON REPORT OF WELL No. MW-3 Sheet 1 of 1
PROJECT: Forest Oaks Circle K
PROJECT NO: 1354-09-167 A
PROJECT LOCATION: Greensboro, NC
DRILLING CONTRACTOR: Brown Environmental
DRILLING METHOD: Auger
DATE DRILLED: 11/3/09
STRATA
WELL ::t: ..J Ii:~ 0 ::i::: DETAILS Ill ti:~ w5. DESCRIPTION :: 0 >-UJ~
(/) 0
0 0.00
Topsoil
Gray Green Clayey
SILT
Gray Sandy SILT
... 5
Brown Sandy SILT
-10
15
0 z w
(!) w ..J
GS
WATER LEVEL:
LATITUDE :
LONGITUDE:
TOP OF CASING ELEVATION: 834.98
z
0
~~
~$ w
..J w
DATUM: MSL
LOGGED BY: W. Watterson
WELL CONSTRUCTION DETAILS
PROTECTIVE CASING
Diameter:
Type: Manhole Cover
Interval:
RISER CASING
Diameter: 21nches
Type: PVC
Interval: 0.2-7
GROUT
Type: Neat Cement
Interval: 0-3
SEAL
Type: Bentonite
Interval: 3 -5
FILTERPACK
COMPLETION REPORT OF WELL No. MW-4 Sheet 1 of 1
PROJECT: Forest Oaks Circle K
PROJECTNO: 1354-09-167A
PROJECT LOCATION: Greensboro, NC
DRILLING CONTRACTOR: Brown Environmental
DRILLING METHOD: Auger
DATE DRILLED: 11 /3/09
STRATA WELL ::c: __,
t:: "' 0 ::c: DETAILS DESCRIPTION ID Ii:"' wS ~ 0 >-w5.
Cl) C
0 0.00
Topsoil ,-
Tan Brown Sandy
SILT
5
10
Very Hard Tan Gray
Silty Sand
15
Cl z w
(!) w
..J
GS
WATER LEVEL:
LATITUDE:
LONGITUDE:
TOP OF CASING ELEVATION: 834.98
DATUM: MSL
LOGGED BY: w. Watterson
z
0
i=-~~ WELL CONSTRUCTION DETAILS
w
..J w
PROTECTIVE CASING
Diameter:
Type: Manhole Cover
Interval:
RISER CASING
Diameter: 21nches
Type: PVC
Interval: 0.2-4.5
GROUT
Type: Neat Cement
Interval: 0-1
SEAL
Type: Bentonite
Interval: 1-2
FILTERPACK
EnviroClean
Degassing/Hydrocarbon Removal/Remediation Chemistry
PHYSICAL PROPERTIES
Product Name
Physical Form
Color
EnviroClean
Clear Liquid
Colorless unless dyed
Specific Gravity (Water= 1)
Solubility in Water
Freezing/Melting Point
Flash Point (°F)
pH
Reportable Quantity (RQ)
1.028 +/-.01
100%
NE
>200° F
8.5 +/-.25
None
Complete information on health hazards, protective
equipment, handling precautions, environmental
hazards and disposal Is listed in the current
EnviroClean Safety Data Sheet (SDS) for this product.
SUMMARY
EnviroClean is a non-flammable, non-toxic,
water-based, proprietary blend of non-ionic
ethoxylated octylphenolic surfactants that has
been specifically engineered as a
cleanup/mitigation agent for a wide range of
hydrocarbon products . EnviroClean has been
shown to be effective for quickly and effectively
suppressing or completely eliminating voes,
LEL's, benzene and low levels of H2S and
mercaptans in open or confined spaces.
EnviroClean has been used for cleanup of
hydrocarbon spills and soil remediation. In these
applications, EnviroClean effectively conditions
(physically) the hydrocarbon such that the
microbes that naturally occur can more readily
consume it. It turns hydrocarbons into a nutrient
source for the microbes . When sufficiently mixed
with hydrocarbon and water, the EnviroClean
forms a homogeneous solution of hydrocarbon ,
EnviroClean and water, which is very stable.
EnviroClean is a concentrated product that
readily biodegrades.
EnviroClean is commercially available in 5-gallon
units, 55-gallon drums, 275 and 330-gallon totes
and bulk from Oklahoma City, Oklahoma and
Houston, Texas.
Page 1 of 2
FLUID DESIGN
EnviroClean is a proprietary blend of surfactants
that needs to be diluted to be effective and it is
very safe to workers and the environment.
EnviroClean does not contain caustic, therefore
does not have the common harmful side effects
associated with caustic based products. The
product is designed for use as a degassing agent
and a cleaner/degreaser for remediation. The
product does not contain any enzymes or
biomass itself. It works by conditioning the
hydrocarbon so that the naturally occurring
microbes (bacteria) are able to readily consume
it. Through the application of the appropriate
dilution and mixing, the EnviroClean will capture
the hydrocarbon and tie it up in a solution that is
very stable . The formation of this solution results
in extremely small particles that will not
recoalesce . It is important to note that if
EnviroClean reaches its saturation point the
oversaturated hydrocarbon will breakout of
solution very quickly. This will allow for easy
removal or reclamation of any hydrocarbon that is
not preconditioned for remediation.
In addition to tying up the hydrocarbon in
solution, the product is very effective when
contacted with hydrocarbon vapors at
suppressing volatile organic vapors, gases, and
odors. Once combustible and flammable
hydrocarbon vapors are tied up in the resultant
solution, the solution will be very difficult to ignite .
It also accelerates the biodegradation process of
the hydrocarbon, thereby enhancing recycling or
reclamation of water.
EnviroClean has been demonstrated to be
effective on gas, oil, lube oil , hydraulic oil, most
petroleum-based products, animal and vegetable
oils, fats, and tallow oils. EnviroClean cleans the
heavy tar build-up, asphaltenes or oily residue
from inside of tanks and vessels. Furthermore
once a surface has been cleaned with
EnviroCtean, the cleaned surface will resist the
deposition of oily materials.
EnviroClean can be used to cleanup oil spills
whether in/on soil or hard surfaces. The first step
in this process is to remove as much of the free
oil as possible. This step is followed by
contacting the contaminated . surface
appropriately with the proper dilution of
EnviroClean and water. The treatment solution
will contact the hydrocarbon molecules and
change their behavior such that they are now
essentially water soluble. The large increase in
interfacial surface area creates conditions that
are favorable to degradation and consumption by
bacteria and microbes. The product converts
hydrocarbons into a very good nutrient source for
bacteria and microbes.
EnviroClean is typ(cally fed at concentrations
between 1 % and 6%, depending on the nature of
the hydrocarbon contamination problem. It can
be diluted with most types of water -hard, soft or
brackish water. The product has an unlimited
shelf life when unopened. EnviroClean is
effective at ambient temperatures. However, the
effectiveness will increase as the tem perature
of the a lication is increased. EnviroClean
does not require the use of steam, but has been
shown to be very effective when injected into the
steam (vapor) phase.
FIELD MIXING PROCEDURES
Mixing Concentrates
EnviroClean is usually delivered as a concentrate
and must be diluted with water to work properly.
Cleaning solutions can be formulated by
premixing or eduction. It is not necessary to
provide high shear agitation when preparing a
batch of cleaning solution since EnviroClean is
100% soluble in water. It is recommended that
when preparing the cleaning solution you first
add the water into the mix container and then
follow by the addition of EnviroClean. This will
minimize foaming as the EnviroClean and water
form a homogeneous solution.
For premixing, the following procedure may be
used:
1. Add the correct amount of water to the
container.
2. Depending on the desired strength, add
the correct amount of EnviroClean to the
container.
3. If the final solution is not a consistent
pink color, mild agitation may be
required until a consistent pink color is
achieved.
Quality Control Testing
There is no easy field testing procedure to
monitor the concentration of active ingredients in
the EnviroClean formulation. Visually the color
changes from rose color to lighter pink as the
product is further diluted. Effectiveness can also
be predicted by quantifying the amount of
hydrocarbon that is to be picked up. By
observing the effluent from the use of
EnviroClean, an adjustment in the cleaning
solution concentration can be made. If it is
observed that free oil is floating on the effluent
Page 2 of 2
solution, then the concentration should be
increased.
MATERIAL REQUIREMENTS
For specific protocols and application rates,
please refer to the available Product Usage
Guide, product label, or consult with the
manufacturer or authorized distributor for
additional guidance.
SECTION I
ENV1ROtZLEAN
SAFETY DATA SHEET
MATERIAL IDENTIFICATION
PRODUCT NAME / DESCRIPTION: EnviroClean
DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES
PO BOX 721090
OKLAHOMA CITY, OK 73172
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
Skin Corrosionllrritation
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 dustlfumelgaslmistivaporslspray
Use only outdoors or in a well ventilated area
Wash all exposed skin thoroughly after handling
Avoid release to the environment

ENV1RGl EAN
Store in a well ventilated place
TOXICITY INFO:
See Section 1 l .
SECTION 3
HEALTH HAZARDS
CHEMICAL NAME
%WIW CAS NUMBER
(Proprietary Formula)
Proprietary Blend of Ethoxylated Octyiphenolic 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:
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.
Eyes:
Skin:
Inhalation:
Ingestion:
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 15 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.

ENVIR
SECTION 6 ACCIDENTAL RELEASE MEASURES
Personal Precautions, PPE, and Emergency Procedures:
Wear protective clothing as described in Section 8 of this safely 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 dosed 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

EN'VI RGLEAN
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
NIA
>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
N/A
Test 1 Result
Route
Species
See Section 4 for symptoms.
CARCINOGENICITY:
No known carcinogens, mutagens, or reproductively toxic ingredients
SECTION 12
ECOLOGICAL INFORMATION
Raw Material
Test
Result
Time
Species
NIA
PERSISTENCE & DEGRADABILITY:
NE

ENVIR
BIOACCUMULATION:
NE
MOBILITY
NE
LEAN
SECTION 13 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 IS 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 ADMINIS'[RATION): NA
TOXIC SUBSTANCES CONTROL ACT (TSCA): NA
IATA: NA

ENV1RO LEAN
s+rooIJCT
NFPA HAZARD INFORMATION SIGN
[o]
[0]
4 — DEADLY
3 — EXTREME DANGER
2 — HAZARDOUS
1 — SLIGHTLY HAZARDOUS
0 --NORMAL MATERIAL
FLASH POINTS:
4—BELOW73F
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
J] 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.

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LEGEND
TYPE II MONITORING WELL LOCATION
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'ESTIMATED EXTENT OF
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ESTIMATED EXTENT OF
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05/11/16
E ;txLATED EXTENT OF ROQINE Ri
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MOORED (xr(1i'I' 6F TOTAL EREX
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