WI0400483_DEEMED FILES_20180606

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North Carolina Department of Environmental Quality -Division of Water Resources
INJECTION EVENT RECORD {IER)
Permit Number WI0400483 --,....-_-_-_-_::-_-_-_-_-_-_-_-_::-_-______________ _,,
1. Permit Information
NCDEQ
Permittee
163 Service & Groce ry
Facility Name
5087 NC Highway 163
Facility Address (include County)
2. Injection Contractor Information
ATC Associates of North Carolina. P.C.
Injection Contractor/ Company Name
Street Address 7606 Whitehall Executiv~ Ctr. Dr.
%~
Charlotte NC 28273 ~O~
City State Zip Jade · ~
UM_) 529-3200
Area code -Phone number
3. Well Information
Wo Ir& ,~. _. G ~n ~lo,,. vv~t. _· 'V/p
~IQ 61rQ c.,
fOe~&·t,"~
°""' Number of wells used for injection __ 1~--
Well IDs MW-1
Were any new wells installed during this injection
event?
D Yes [xi No
If yes, please provide the following information:
Number of Monitoring Wells _____ _
Number oflnjection Wells _______ _
Type of Well Installed (Check applicable type):
D Bored D Drilled D Direct-Push
D Hand-Augured D Other (specify) __ _
Please include a copy of the GW-1 form for each
well installed.
Were any wells abandoned during this injection
event?
D Yes [XI No
If yes, please provide the following information:
Number of Monitoring Wells _____ _
Number oflnjection Wells _______ _
Please include a copy of the GW-30 for each well
abandoned.
4. lnjectant Information
P rovectus ORS (oxygen-releasing socks)
Injectant(s) Type (can use separate additional sheets
if necessary
Concentration 75-85% Cakium Peroxide
If the injectant is diluted please indicate the source
dilution fluid. ·------------
Total Volume Injected (gal)_3,:;.:3:;..;;9"""'.3~in::...3 ____ _
Volume Injected per well (gal)_3_3_9_.3_1_· n_3
___ _
5. Injection History
Injection date(s).__c__5...:./2;...2;_/1...:.8 ________ _
Injection number ( e.g. 3 of 5)--=-1-"o-=-f -"-l ___ _
Is this the last injection at this site?
D Yes ~ No
I DO HEREBY CERTIFY THAT ALL THE
INFORMATION ON THIS FORM IS CORRECT TO
THE BEST OF MY KNOWLEDGE AND THAT THE
INJECTION WAS PERFORMED WITHIN THE
ST _ND -Rf~AID OUT IN THE PERMIT.
✓ fr-t'-~ ,~,. -v' 6/1/18
s f.6NA 'l"HR-i! OF INJECTION CONTRACTOR DATE
Submit the original of this form to the Division of Water Resources within 30 days of injection.
Attn: UIC Program, 1636 Mail Service Center, Raleigh, NC 27699-1636, Phone No. 919-807-6464
Form UIC-IER
Rev. 3-1-2016
Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0400483
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
163 Service & Grocery NCDEQ lncident#3320
Location Address
5087 NC Hwy 163
West Jefferson NC
Owner
Owner Name
Ncdeq State -Lead Program
Dates/Events
Orig Issue
5/21/2018
App Received
5/7/2018
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
28694
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS __ SWP
5/21/2018
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Winston-Salem
County
Facility Contact Affiliation
Owner Type
Government -State
Owner Affiliation
Mark Petennann
1646 Mail Service Ctr
Raleigh
Ashe
Issue
5/21/2018
Effective
5/21/2018
NC 27699164
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasln
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 15A NCAC 02C .0200 (NOTE: This form must be received at least 14 DAYS p rior to injection)
AQUIFER TEST WELLS (ISA NCAC 02C .0220 )
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.
IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Passive Injection S ystems -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks, iSOC systems, and other gas infusion methods (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).
2) Small-Scale Injection O perations -Injection wells located within a land surface area not to exceed I 0,000
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 jection 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: =M=a'-'-v~2~--~ 2018 PERMIT NO. W :l O '+ 0 0 'f 8 3 (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
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
X __ Passive Injection System ............................... Complete sections B through F, H-N
___ Small-Scale Injection Operation ...................... Complete sections B through N
___ Pilot Test ................................................. Complete sections B through N
T I · · w 11 c 1 . . ."' . . .1t., qj,; . rowR ___ racer nJectlon e . .. . .. . . . . . . . . . . .. . . . . . . . . . . . .... .. omp ete~t · 1L1 ,e} _ IJ,1, 0 1~~
STATUS OF WELL OWNER: Choose an item. MAY -7 2018
. r Qualit',' Regionn\ Wate . 8 on
WELL OWNER(S) -State name of Business/Agency, and Name and Title of f b'i'S-0 .t· e~~ate authority to
sign on behalf of the business or agency:
Name(s): NCDEO -State Lead Program
Mailing Address: 1646 Mail Service Center
City: Raleie h State: NC Zip Code: _27_6_9_9 _______ County: Wake
Day Tele No.: 919-707-8260 Cell No.: Not Available
EMAIL Address: andrew.de pp ensmith@ atc gs.com Fax No.: --~9=19~-~70~7--8=2=6~0 _____ _
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page 1
D. PROPERTY OWNER(S) (if different than well owner/applicant)
Name and Title: 163 Service & Groce ry
Company Name ---------------------------------
Mailing Address: 5087 NC Highway 163
City: WestJefferson State: NC Zip Code:.--=28=6=9---'4 ____ County:_A_s_h_e ___ _
Day Tele No.: 336-877-5454 Cell No.: ----=N""'"o""'t"""A=v-'-'a=i=la=b=le'-------
EMAIL Address: Not Available Fax No.: ------"-N""'o'-"-t -=-A=-v"""a=il=a=bl=e'-----__ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: ___ An_d_r_e_w_D_ep,_.p-e_n_sm_ith_-_P_r_o~je_c_t~S_c_ie_n_ti~st~---------------
Company Name ---"-'A'-"T-=Ca...A=-=ss=o'-"c=ia=t=es'--o=f,_,N'--'=ort=-==h-=C=ar=-o=l=in=a=-. -=-P-'-'.C"'-'.'--------------------
Mailing Address: __ ___,_7"""6--=-0-=-6 ~Wh"-=i=te=h=a=ll"""'E=x=e=c""'ut=iv-'-e=-=C--=-e=nt=e-=--r =D--=-r=iv"""e_,_. =S=m=·te"-=80-=-0"-----------
City: Charlotte State: NC Zip Code:~28=2~7~3 ____ County: Mecklenburg
Day Tele No.: 704-529-3200
EMAIL Address: andrew.de pp ensmith@atc gs.com
F. PHYSICAL LOCATION OF WELL SITE
Cell No.: 704-281-3281
Fax No.: 704-529-3272
(1) Facility Name & Address: 163 Service & Grocerv -NCDEO Incident #3320 -5087 NC Hi ghway 163
City: West Jefferson County: Ashe County Zip Code: =28=--6=9~4'-----
(2) Geographic Coordinates: Latitude**: ___ 0 ____ " or 36 °.35311 ___ _
Longitude**: 0 __ "or -81 °.43928 ___ _
Reference Datum: ___ W_G_S_8_4 ___ Accuracy: Not Available
Method of Collection:----'G=o=o""g""l-=-e=E=a=rt=h ____________ _
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITH PROPERTY
BOUNDARIES MAY BE SUBMITTED IN LIEU OF GEOGRAPHIC COO RD INA TES.
G. TREATMENT AREA
Land surface area of contaminant plume: _______ square feet
Land surface area ofinj. well network: square feet(::: 10,000 ft2 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
(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. 3.21.2018 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 .
ATC will install Provectus ORS (ox vgen-releasing socks) in monitorin g well MW-1 to promote accelerated
petroleum compound biodegradation and reduce compound concentrations to below the North Carolina
Groundwater Quality Standards (2L Standards ). The socks come in 3-foot sections and three socks are
anticipated to be installed in well MW-1 during the installation events. dependin g on water volume in the well.
The socks will deliver controlled-release ox gen into the groundwater for four to eight months. at which point
the chemicals in the socks will have depleted.
J. APPROVED INJECTANTS -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 i'njectants can be found online at http ://deg.nc.aov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/g,round-water-protection/ground-water-approved-injectants .
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info (919-
80 7-6496).
Injectant: ----=P'--'r'""'o-'-v-=-ec=-=tus=-=O=R=S'--------------------------
Volume of injectant: ----'3~so=c=k=s---'a=t--=1--=1=3=. l'-1=· n=. 3..:../s""o""'c=k=: ""'to=t=a=--1 v..:..o=l=um=e'-=----=3=3-=--9=.3'--'i=n"'". 3--'p""e=r--=i=n=st=a=ll=at=io=n......,.ev..:..e=n=t'--_
Concentration at point of injection: ___ 7..:..5=-----=8=5~3/c-"-o ~c=al=c=iu=m=--p"""e-=-ro=x=i=de-=--------------
Percent if in a mixture with other injectants: --~7-=5_--"-85=--0~1/o'-c=a=lc=i=um~p.,..e=r--=o=x=id=e'--'(~1=5~-2=5=--0~1/o~i=n=o-=--rn=a=n=ic
nutrients)
Injectant: ----------------------------------
Volume of injectant: _____________________________ _
Concentration at point of injection:
Percent if in a mixture with other injectants: ____________________ _
Injectant:
Volume ofinjectant: _____________________________ _
Concentration at point of injection:
Percent ifin a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(1) Number of injection wells: _____ .Proposed __ ~l~ __ 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 pennanent, 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 NOi Rev . 3-21-2018 Page 3
L. SCHEDULES -Briefly describe the schedule for well construction and injection activities.
A pproximately two weeks followin g submittal of this NOL ATC will install three socks in existing well MW-1.
It is antici pated that chane:e-outs may occur on a q uarterl basis.
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 02L result from the injection activity.
A pproximate semi-annual sampling events in monitoring well MW-1 will be performed starting six months after
the installation of these socks. During each sam pling event ATC will collect a samp le from the well for analvsis
of volatile organic compounds (VOCs) b v EPA Method 6200B. ATC will also measure dissolved oxygen.
conductivity. temperature. pH . and oxygen reduction potential in the well during sampling events.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well Owner/App licant: "I hereby certify, under penalty of law, that I 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, I 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 submittingfalse information. I agree to construct, operate, maintain, repair, and if applicable, abandon the
injection_ well and all related appurtenances in accordance with the 15A NCAC 02C 0200 Rules. "
I
.1,~·:""">"'1 . .::.. . . on behalf ofNCDEQ Andrew De pp ensmith. on behalf ofNCDEQ
, Sigrniture of Applicant Print or Type Full Name and Title
Pro pe rty Owner (if the propertv is not owned b y the Well Owner/A pp licant):
"As owner of the property on which the injection well(s) are to be constructed and operated, I 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
(15A NCAC 02C .0200)."
"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.
NCDEO UST State Lead Pro gram -Herb Berger
Signature* of Property Owner (if different from applicant) Print or Type Full Name and Title
* An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of this NOi along with a copy on an attached CD or Flash Drive at least
two (2) weeks prior to injection to:
DWR -UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 3-21-2018 Page4
TABLE4
MONITORING WELL CONSTRUCTION DETAILS AND GROUNDWATER ELEVATION DATA
163 Service & Grocery
Well Casing
5087 Highway 163
West Jefferson, North Carolin 28694
NCDEQ Incident #3320
Well Screen Depth to Well ID Date Installed Depth Depth of Well Interval TOC Elevation Gauging Date Groundwater
7/30/2009 5.10
4/13/2010 5.1
10/13/2010 8.35
MW-1 4/1/2003 10 20.00 10-20 Unknown 7/13/2011 6.74
3/20/2012 6.00
7/24/2013 2.91
10/2/2017 7.92
7/30/2009 4.90
4/13/2010 4.90
10/13/2010 7.53
MW-2 5/13/2004 5 15.00 5-15 Unknown 7/13/2011 6.27
3/20/2012 3.72
7/24/2013 2.38
10/2/2017 5.76
Notes :
Top of casing elevations have not been surveyed to date.
0 500 1 000
2 000
APPROXIMATE SCALE IN FEET
REFERENCE: USGS 7.5-MINUTE MAP, GLENDALE SPRINGS,
NORTH CAROLINA. DATED 2016
TITLE FIGURE 1
SITE LOCATION MAP
163 SERVICE & GROCERY
5087 NC HIGHWAY 1
WEST JEFFERSON, ASHE
- NCDEQ INCIDENT #3320
63
COUNTY, NORTH CAROLINA
ATC
ASSOCIATES OF NORTH CAROLINA, P.C.
Chariot*. North Carona 2 (704) 5 0-02DO FAX 52A-3272
CAD FILE
3320_SM
TYPL COD
PREP. BY
AD
REV. BY
FL
SCALE
AS SHOWN
DAT
10.13.17
PROJECT NO.
5LP0332001

CANOPY A
1I
DISPENSER
Former
B
NE]1LE KNOB
ROAD
IMAGE SOURCE NC GEOSPATIAL DATABASE
0
15
30
60
APPROXIMATE SCALE IN FEET
EXPLANATION
PROPERTY BOUNDARY
• MONITORING WELL LOCATION
TITLE FIGURE 3
SITE MAP
163 SERVICE & GROCERY NCDEQ INCIDENT #3320
5087 NC HIGHWAY 163
WEST JEFFERSON, ASHE COUNTY, NORTH CAROLINA
ATC
ASSOCIATES OF NORTH CAROLINA, P.C.
Chmioilay North Cortina 28273 p0415-3200 FAX swan
CAD FILE
3320_SM
TYPE CODE
PREP. BY
AD
REV. BY
FL
SCALE
AS SHOWN
DATE
10.13.17
PROJECT NO.
SLP0332001

rovectus
ENVIRONMENTAL PRODUCTS"
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 1 of 5
1. PRODUCT IDENTIFICATION: PROVECT-ORS
PRODUCT USE: Soil and water treatment.
MANUFACTURER: EMERGENCY PHONE:
PROVECTUS ENVIRONMENTAL
2871 W. Forest Rd., Suite 2
Freeport, IL
61032
USA: 415) 650-2230
TRANSPORTATION OF DANGEROUS GOOD CLASSIFICATION:
Oxidizing Solid, n,o.s- (Calcium Peroxide), Class 5.1, PG 11, UN1479
WHMIS CLASSIFICATION:
Oxidizer
2. COMPOSITIONI1NFORMATION ON INGREDIENTS
Ingredients
Calcium Peroxide
Inorganic Nutrients
3. PHYSICAL DATA
Chemical Formula
CaO,
CAS No. Percentage
1305-79-9 75%-85%
15%-25%
Appearance White & brown granules
Physical stateSolid
Odor threshold None
Bulk Density 500-650g/L
Solubility in Water Insoluble
pH _ —11
Decomposition Temperature Self -accelerating decomposition with oxygen release starting from 275
degrees Celsius
4. HAZARDS IDENTIFICATION
Emergency overview
Oxidizing agent, contact with other material may cause fire. Under fire conditions this material may
decompose and release oxygen that intensifies fire. This product contains <1 % non -respirable crystalline
silica. The NTP and OSHA have not classified non -respirable crystalline silica as carcinogenic. Long term
exposure to hazs+rdous levels of respirable silica dusts can cause lung disease (silicosis). ORS does not
contain respirable crystalline silica
Potential Health Effects:
■ General Irritating to mucous membrane and eyes.

rovectus
p
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET:
PROVEOT-ORS Page: 2 of 5
• Inhalation Irritating to respiratory tract. Long term inhalation of elevated levels
may cause lung disease (silicosis).
• Eye contact May cause irritation to the eyes; Risks of serious or permanent eye
lesions.
• Skin contact _ May cause skin irritation.
• Ingestion Irritation of the mouth and throat with nausea and vomiting.
5. FIRST Am MEASURES
• Inhalation Remove affected person to fresh air_ Seek medical attention if effects
persist.
• Eye contact Flush eyes with running water for at least 15 minutes with eyelids
held open. Seek specialist advice.
• Skin contact Wash affected skin with soap and mild detergent and large amounts of
water.
• Ingestion If the person is conscious and not convulsing, give 2-4 cupfuls of
water to dilute the chemical and seek medical attention immediately.
Do not induce vomiting.
6. FIRE FIGHTING MEASURE
Flash Point
• Not applicable
Flammability
• Not applicable
Ignition Temperature
• Not applicable
Danger of Explosion
• Non -explosive
Extinguishing Media
• Water
Fire Hazards
• Oxidizer_ Storage vessels involved in a fire may vent gas or rupture due to internal pressure.
Damp material may decompose exothermically and ignite combustibles. Oxygen release due to
exothermic decomposition may support combustion. May ignite other combustible materials.
Avoid contact with incompatible materials such as heavy metals, reducing agents, acids, bases,

•
L)rovectus
ENVPRONMPNTAL PRODUCTS"
MATERIAL SAFETY DATA SHF.FT:
PROVECT-ORS Page: 3 of 5
combustible (wood, papers, cloths etc.) Thermal decomposition releases oxygen and heat.
Pressure bursts may occur due to gas evolution_ Pressurization if confined when heated or
decomposing. Containers may burst violently.
Fire Fighting Measures
• Evacuate all non -essential personnel
• Wear protective clothing and self-contained breathing apparatus.
• Remain upwind of fire to avoid hazardous vapors and decomposition products.
• Use water spray to cool tire- exposed containers.
7. ACCIDENTAL RELEASE MEASURES
Spill Clean-up Procedure
• Oxidizer_ Eliminate all sources of ignition. Evacuate unprotected personnel from equipment
recommendations found in Section 9_ Never exceed any occupational exposure limit.
• Shovel or sweep material into plastic bags or vented containers for disposal. Do not return spilled
or contaminated material to inventory. Avoid making dust_
• Flush remaining area with water to remove trace residue and dispose of properly, Avoid direct
discharge to sewers and surface waters. Notify authorities if entry occurs.
• Do not touch or walk through spilled material. Keep away from combustibles (wood, paper, oils,
etc.). Do not return product to container because of risk of contamination.
S. HANDLING AND STORAGE
Storage
• Oxidizer. Store in a cool, well -ventilated area away from all source of ignition and out of direct
sunlight. Store in a dry location away from heat.
• Keep away from incompatible materials. Keep containers tightly closed_ Do not store in
unlabeled or mislabeied containers.
• Protect from moisture. Do not store near combustible materials. Keep containers well sealed.
Ensure pressure relief and adequate ventilation.
• Store separately from organics and reducing materials. Avoid contamination that may lead to
decomposition.
Handling
• Avoid contact with eyes, skin, and clothing. Use with adequate ventilation.
• Do not swallow. Avoid breathing vapors, mists, or dust. De not eat, drink, or smoke in work
area.
• Prevent contact with combustible or organic materials.
• Label contaiuers and keep them tightly closed when not in use.
• Wash thoroughly after handling.

` rovectus
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET:
PROVECT-ORS Page: 4 of 5
9. EXPOSURE CONTROLS/PERSONAL PROTECTION
Engineering Controls
• General room ventilation is required. Local exhaust ventilation, process enclosures or other
engineers controls may be needed to maintain airborne levels below recommended exposure limits.
Avoid creating dust or mist. Maintain adequate ventilation. Do not use in closed or confined
spaces. Keep levels below exposure limits. To determine exposure limits, monitoring should be
performed regularly.
Respiratory Protection
• For many condition, no respiratory protection may be needed; however, in dusty or unknown
atmospheres or when exposures exceed limit values, wear a NLOSH approved respirator.
Eye/Face Protection
• Wear chemical safety goggles and a full face shield while handling this product.
Skin Protection
• Prevent contact with this product. Wear gloves and protective clothing depending on condition of
use_ Protective gloves: Chemical -resistant (Recommended materials: PVC, neoprene or rubber)
Other Protective Equipment
• Eye -wash station
• Safety shower
• Impervious clothing
• Rubber boots
General Hygiene Considerations
• Wash with soap and water before meal times and at the end of each work shift. Good
manufacturing practices require gross amounts of any chemical removed from skin as soon as
practical, especially before eating or smoking.
10. STABILITY AND REACTIVITY
Stability
• Stable under normal conditions
Condition to Avoid
• Water
• Acids
• Bases
• Salts of heavy metals
• Reducing agents
• Organic materials
■ Flammable substances
Hazardous Decomposition Products
■ Oxygen which supports combustion

rovectus
ENVIRONMENTAL PRODUCTS'
MATERIAL SAFETY DATA SHEET.
PROVECT-ORS Page: 5 of 5
11, TOXICOLOGICAL INFORMATION
• 1.1350 Oral: Min.2000 mg/kg, rat
• LD50 Dermal: Min. 2000mglkg, rat
• LD50 Inhalation: Min. 4580 mg/kg, rat
12. ECOLOGICAL INFORMATION
Ecotoxieological Information
• Hazards for the environment is limited due to the product properties of no bioaccumuladon, weak
solubility and precipitation in aquatic environment.
Chemical Fate Information
• As indicated by chemical properties oxygen is released into the environment.
13. DISPOSAL CONSIDERATIONS
Waste Treatment
• Dispose of in an approved waste facility operated by an authorized contractor in compliance with
local regulations.
Package Treatment
• The empty and clean containers are to be recycled or disposed of in conformity with local
regulations.
14. TRANSPORT INFORMATION
• Proper Shipping Name: MC-O
• Hazard Class: 5.1
• Labels: 5.1 (Oxidizer)
• Packing Group: II
15. REGULATORY INFORMATION
• SARA Section Yes
• SARA (313) Chemicals No
• EPA TSCA Inventory Appears
• Canadian WHM1S Classification ... C, D2B
• Canadian DSL Appears
• E1 NECS Inventory Appears