WI0400496_DEEMED FILES_20190114

D~ Print Form
WELL CONSTRUCTION RECORD (GW-1} For Internal Use Only:
1. Well Contractor Information:
I 1am W lk a er 14. WATER WNES
Well Contractor Name
FROM TO DESCRIPTION
4237-B
ft. ft.
ft. ft.
NC Well Contractor Certification Number 15. OUTER CASING (for multi-used wells! OR LINER (If a pp licable )
W Walker Environmental Service LLC FROM I TO I DIAMETER I THICKNESS MATERIAL
ft. ft. in.
Company Name
Wl400496 16. INNER CASING OR TUBING C2eotbermal dosed-loo ol
2. Well Construction Permit#: FROM TO DIAMETER THICKNESS MATERIAL
Lisi all applicable well constnrction permits (i.e. UIC, County, State, Variance, etc.) ft. ft. in.
3. Well Use (check well use): ft. ft. in.
Water Supply Well: 17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
CJ Agricultural □Municipal/Public 0 ft. ft. in.
t:Joeothennal (Heating/Cooling Supply) □Residential Water Supply (single) ft. ft. in.
J Industrial/Commercial □Residential Water Supply (shared) IS.GROUT
,Irri11ation FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
Non-Water Supply Well: ft. ft.
~Monitoring □Recovery ft. ft.
Injection Well:
:J!Aquifer Recharge @Groundwater Remediation
ft. ft.
19, SAND/GRAVEL PACK {if aoo licablel
jAquifer Storage and Recovery □salinity Barrier FROM TO MATERIAL EMPLACEMENT METHOD
:}Aquifer Test Cstormwater Drainage ft. ft.
:]Experimental Technology □Subsidence Control ft. ft.
J)Geothermal (Closed Loop) □Tracer 20. DRILLING LOG (stlllch addltloul >mW if n•ces~rvl
,Geothermal (Heating/Cooling Return) nether ( explain under #21 Remarks)
•'RO.\I ·10 l>E..~CRIP110"'-(color, han:lno,. soiVr odc '''D<', nrain s17.e, etc.)
ft. ft.
4. Date Well(s) Completed: 11 / 18/ 18 Well ID# IP-N-1 & IP-N-2 ft. ft.
Sa. Well Location: ~~c~,v~D1Nc. ft. ft.
Former Stanley Black & Decker Plant o'=°Q ft. ft. vo,~ ft. ft.
ft. ft. F1c758S~F~yetteville St. AshF;b~r~~r1cib~05 l
Physical Address, City, and Zip . ~egi Wa1'1! ft. ft.
Randolph 0
"0 1 op ~"'6,otNcoea, 21. REMARKS
~"e ~l'YH
County Parcel Identification'~IOJ>
Sb. Latitude and longitude in degrees/minutes/seconds or de ~y :z Of!
if well field, one lat/Ion is sufficient ( g r ... .,~. WiliamWAlt.er
35.680779
22. Certification. ~ 1 ""''"_..:::;::.....,.-w
79 821869 u_1
~ .,,./# ~;.._Walbrfllvln:inmentalService,,o"-
N • .-vater Qy;w'W • -vJL(__--=~Vlranmenlal('gmallc 1/13/19 ------------Qegi ,ria, Op . 1'T I o.ie,o,,o,u,1:43:os-os'OO'
erations s -..... . .,
6. Is(are) the well(s)QPermanent or @Temporary -v.,,....-ture of Certified WeU Contractor Date
7. Is this a repair to an existing well: []Yes or IB)No
If this is a repair.fill out known well conslnrction information and explain the nature of the
repair 1111der #21 remarks section or on the back of this form.
8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction, only l GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:._2 __________ _
9. Total well depth below land surface: _2_7_t _o_2_8 _______ (ft.)
For multiple wells list all depths if different (example-3@200 • and 2@100')
10. Static water level below top of casing: ____________ (ft.)
If water level is above casing. use "+"
11. Borehole diameter: _2_._2_5 ____ (in.)
12. Well construction method: _n_a _______________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _______ Method of test: _______ _
By signing this form, I hereby certify that the wel/(s) was (were) constructed in accordance
with 15A NCAC 02C .0100 or 15A NCAC 02C .0200 Well Const1'llction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages ifnecessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: fu addition to sending the form to the address in 24a
above, also submit one copy of this form within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supph• & Injection Wells: In addition to sending the form to
the address(es) above, also submit one copy of this form within 30 days of
Ll::3:.:b::_. :D:.:_is::i:nt::e::c.:ti:o.:n_:typ~e:.::.=======:..._.:_:A:::m:::o:.:u::n:_:t.:_: ========::..J completion of well construction to the county health department of the county
where constructed.
FonnGW-1 Nonh Carolina Department of Environmental Quality-Division of Water Resources Revised 2-22-2016
WELL CONSTRUCTION RECORD (GW-1}
I. Well Contractor Information:
w· W lk 111iam a er
Well Contractor Name
4237-B
NC Well Contractor Certification Number
W Walker Environmental Service LLC
CompanyName . • w,400496 2. Well Construction Penmt #:
List all applicable well const111ction permits (i.e. UIC, County, Stare, Variance, etc.)
3. Well Use (check well use):
Water Supply Well:
Agricultural 0Municipal/Public
:JGeothennal (Heating/Cooling Supply) []Residential Water Supply (single)
J i Industrial/Commercial □Residential Water Supply (shared)
I Irrig ation
Non-Water Supply Well:
M Monitoring □Recovery
Injection Well:
:]Aquifer Recharge mi) Groundwater Remediation
b Aquifer Storage and Recovery □salinity Barrier
tJ Aquifer Test []stonnwater Drainage
'.]Experimental Technology IJI Subsidence Control
:)Geothennal (Closed Loop) QTracer
,aeothennal (Heating/Cooling Return) n other ( explain under #21 Remarks)
4. Date Well(s) Completed: 11 /30f 1 S Well ID# IP-SW-6
Sa. Well Location:
Former Stanley Black & Decker Plant
Facility/Owner Name Facility ID# (if applicable)
1758 S. Fayetteville St. Asheboro, NC 27205
Physical Address, City, and Zip
Randolph
County Parcel Identification No. (PIN)
Sb. Latitude and Ion itude in de g g rees/minutes/seconds or decimal de rees: g
(if well field, one lat/long is sufficient)
35.680779 N 79.821869 w ------------
6. Is(are) the well(s)0Permanent or @Temporary
7. Is this a repair to an existing well: 0Yes or IB)No
/ft/tis is a ,·epair.fill out known well const111ctior, information and explain tire r,at11re ofrlre
repair 1111der #21 remarks section or on the back ofthisfonn.
8. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
construction, only 1 GW-1 is needed. Indicate TOTAL NUMBER of wells
drilled:_1 ___________ _
9. Total well depth below land surface: _3_0 ___________ (ft.)
Fo,· multiple wells list all depths if d/ffe,·e11t (example-3@200' and 2@100')
10. Static water level below top of casing: ___________ (ft.)
If water level is above casing, use '"+"
11. Borehole diameter: _2_._2_5 _____ (in.)
12. Well construction method: _N_A ______________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) _______ Method oftest: _______ _
13b. Disinfection type: Amount:
I Print Form
For Internal Use Only:
14, WATER ZONES
FROM TO DESCRIPTION
ft. ft.
ft. ft.
15. OUTER CASING ffor multi-cased wells ) OR LINER Of aDl>licabM
FROM I TO DIAMETER THICKNESS MATERIAL
ft, ft. in.
16, INNER CASING OR TUBING Ce.eothermal closed-loo p)
FROM TO DIAMETER THICKNESS MATERIAL
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SLOT SIZE THICKNESS MATERIAL
0 fL ft. in.
ft. ft. In.
18.GROUT
FROM TO MATERIAL EMPLACEMENT METHOD & AMOUNT
ft. ft.
ft. ft.
ft. ft.
19. SAND/GRAVEL PACK (if applicable)
FROM TO MATERIAL EMPLACEMENT METHOD
ft. ft.
ft. fl,
20. DRILLING LOG l ■l tach addl tlonal_jb"ts If nct .. sal'\'l
FROM TO 01-;.S:CR IPTION (color~ hardness soil/rock tn1 e. £rain slzr etc.)
ft. fL
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
ft. ft.
21,REMARKS
22. Certification: 4 1/?'.7~4,· ' -{/,Jr;___.-
Signature of Certified Well Contractor
Dig:talyllgMdbyW.....,,W,lter
CN: cn-w'illam Walker, o-W
W111lkerEnvlronmenLa1StrvlcN,
w,
ema!l--.nvircnmen!11l@gmeil,c
=·""" Dale: 2019.01.1415:08:54 45'00' 1/13/18
Date
By signing this form, I he,·eby certify /hat the well(s) was (were) constructed in accordance
with 15A NCAC 02C .0/00 or 15A NCAC 02C .0200 Well Co11st111ction Standards ar,d that a
copy of this record has been provided to tire well owr,er.
23. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
construction details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
24a. For All Wells: Submit this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In addition to sending the forrn to the address in 24a
above, also submit one copy of this fonn within 30 days of completion of well
construction to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supp h• & Injection Wells: In addition to sending the form to
the address( es) above, also submit one copy of this fonn within 30 days of
completion of well construction to the county health department of the county
where constructed.
FormGW-1 North Carolina Department of Environmental Quality• Division of Water Resources Revised 2-22-2016
I
WELL ABANDONMENT RECORD
1. Well Contractor Information:
William Walker
Well Contractor Name (or well owner personally abandoning well on his/her property)
4237-B
NC Well Contractor Certification Number
W Walker Environmental Services LLC
Company Name
Wl400496
2. Well Construction Permit#:-~---------------
List all applicable well constn,ction petmits (i.e. UIC, Co1111ty, State, Variance, etc.) ifknow11
3. Well use (check well use):
Water Supply Well:
□Agricultural □Municipal/Public
OGeothermal-(Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (shared)
□Irrig ation
Non-Water Supply Well:
□Monitoring □Recovery
Injection Well:
□Aquifer Recharge !!!Groundwater Remediation
□Aquifer Storage and Recovery □ Salinity Barrier
□Aquifer Test □ Stormwater Drainage
□Experimental Technology □Subsidence Control
□Geothermal (Closed Loop) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain under 7g)
4. Date well(s) abandoned: 11 f 30f18
5a. Well location:
Former Stanley Black & Decker Plant
Facility/Owner Name Facility ID# (if applicable)
1758 S. Fayetteville St. Asheboro, NC 27205
Physical Address, City, and Zip
Randolph
County Parcel Identification No. (PIN)
Sb. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.680779 N 79.821869 ------------
COXSTRUCTION DETAILS OF WELL(S) BEING ABANDONED
w
Attach well consh'tlction record(s) if available. For multiple injection or non-water supply wells
ONLY with the same construction/abandonme11t, you can submit one fonn.
6a. Well ID#: IP-N-1 & IP-N-2
6b. Total well depth: 27 to 2 8 (ft.)
6c. Borehole diameter: _2_.2_5 ____ (in.)
6d. Water level below ground surface: _n_a _______ (ft.)
6e. Outer casing length (if known): _n_a _______ (ft.)
6f. loner casing/tubing length (if known): _n_a _____ .(ft.)
6g. Screen length (if known): _n_a _________ (.ft.)
I For Internal Use ONLY:
WELL ABANDONMENT DETAILS
7a. For Geoprobe/DPT or Closed-Loop Geothermal Wells having the same
well construction/depth, only I GW-30 is needed . Indicate TOTAL NUMBER of
wells abandoned:_2 _______________ _
7b. Approximate volume of water remaining in well(s): _n_a ____ --'(gal.)
FOR WATER SUPPLY WELLS ONLY:
7c. Type of disinfectant used: _______________ _
7d. Amount of disinfectant used: ______________ _
7e. Sealing materials used (check all that apply):
II Neat Cement Grout
D Sand Cement Grout
D Concrete Grout
□ Bentonite Chips or Pellets
D Dry Clay
□ Drill Cuttings
D Specialty Grout □ Gravel
D Bentonitc Slurry □ Other (explain under 7g)
7f. For each material selected above, provide amount of materials used:
200Ibs
7g. Provide a brief description of the abandonment procedure:
Mixed neat cement with water until paint like consistency.
Introduced grout mixture into bore hole.
I' Oigltal!>' s~ned t,y'Mlli,m
8 C tifi ti . w,, .. ,
• er Cft OD. 4.i¾ ~ [ DN·••rn. • .. WilllamWalktt,o-.W I ~A) 1, WalkerEnvlrcnme11llllS.rvlcn,
I a£L--OU,
~ .em11~rwilonmental99mail
' .com,caa US 1/13/18
Signature of Certified Well Contr.iiiior or~~jj'o~~~t'"' ""' Date
By signing this form, I hereby certify that the we/l(s) was (were) abandoned in
accordance with 15A NCAC 02C .0100 or 2C .0200 Well Construction Standards
and that a copy of this record has been provided to the well owner.
9. Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL INSTRUCTIONS
10a. For All Wells: Submit this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Information Processing Unit,
1617 Mail Service Center, Raieigh, NC 27699-1617
10b. For In jection Wells: In addition to sending the form to the address in !Oa
above, also submit one copy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground Injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
toe. For Water Suo plv & Injection Wells: In addition to sending the form to the
address(es) above, also submit one copy of this form within 30 days of completion
of well abandonment to the county health department of the county where
abandoned.
FonnGW-30 North Carolina Department of Environmental Quality -Division of Water Resources Revised 2-22-2016
WELL ABANDONMENT RECORD
Far Internal Use ONLY:
1. Well Contractor Information:
William Walker
Well Contractor Name for well owner persorrafy abandoning well on his/her property)
4237-B
NC Weil ContractorCestificetion Number
W Walker Environmental Services LLC
Company Name
2. Weil Construction Permit 0: Wi400496
Lis! ut1 applicable well construction perarite �.e. UIC Calmly State, Variance. etc,) if ;atoms
3. Well use (check well use):
Water Supply Well:
❑Agricultural
❑Geothermal (Heating/Cooliug Supply)
❑ IndustrialfCornrnercial
❑1rrigation
LIMunicipal/Public
❑Residential Water Supply (single)
❑Residential Water Supply (shared)
Non -Water Supply Well;
❑Monitoring ❑Recovery
injection Well:
❑Aquifer Recharge
❑Aquifer Storage and Recovery
DAquifer Teat
❑Experimental Technology
DGeolhermal (Closed Loop)
❑Geothermal (I-Ieating/Cooling Return)
■ Groundwater Remediation
❑Salinity Barrier
DStarmwater Drainage
❑Subsidence Control
❑Tracer
❑ Other (explain tinder 7g)
4. Date well(s) abandoned: 11/30/18
Sa. Well location:
Former Stanley Black & Dueller Plant
Facility/Owner-Name Facility ID# (if applicable)
1758 S. Fayetteville St, Asheboro, NC 27205
Physical Address. City, and Zip
Randolph
County Parcel idendecatian No. (FIN)
5b. Latitude and longitude in degrees/minutes/seconds or decimal degrees:
(dwell field. one Intliong is sari -toot)
35.680779 N 79.821869
CONSTRUCTION DETAILS OF WELL SI BEING AR.NDQNE.I?
.attach well coxsmrc$ion record(s) tfarailabke For nrrekipleinfection or non-wcrcrsupplr walla
ONLY with she dame cansrrxcsinnlahandanarelrt, you can sishosis are farm
sa. Well DV:I P-S W-6
fib. Total well depth: 30 (ft,)
no. Borehole diameter: 2.25 (in.)
6d. Water level below ground surface: na (ft.)
be. Outer casing length (if known): na
(ft.)
6L loner easing/tubing length (if known): na (ft.)
(ft.)
Form OW-10 North Cnralina oepanrecot of Environmental Quality - Division of Water Rcsources Revised 2-22-W 16
6g. Screen length (if known): na
WELL ABANDONMENT DETAILS
7a. For Geoprobe1DPT or Closed -Loop Geothermal Wells haying the same
well construction/depth, only I GW-30 is needed, Indicate TOTAL NUMBER of
wells abandoned: 1
7b. Approximate volume of water remaining in well(s): na
(gal.)
FOR WATER SUPPLY WELLS ONLY:
7e. Type of disinfectant need:
7d. Amount of disinfectant used:
7e. Sealing materials used (check all tbat apply):
In Neat Cement Grout
❑ Sand Cement Grout
❑ Concrete Grout
O Specialty Grout
O Bentonite Slurry
❑ Bentonite Chips or Pellets
❑ Dry Clay
❑ Drill Cuttings
Cl Gravel
10 Other (explain under 70
7f. For each material selected above, provide amount of materials used:
50 Ibs
7g. Provide a brief description of the abandonment procedure:
Mixed neat cement with water until paint like consistency.
Introduced grout mixture into bore hole_
8. Certification:
L , IAb Im.0 brw•.rw.n
lavrmernenSP
.
0.9a PUS
121WAIr.ci.r.1r teen bru).
Signatureefecrtiled Welt Contractor or Well Owner
1/13/18
pate
By signing this form, 1 hereby terrify that the wells) was (were) abandoned to
accordance with 15A NCAC 02C . 01 00 or 2C .0200 Well Cansirrtction Standards
and that a tarpy of this terns' has been provided to the well owner.
9, Site diagram or additional well details:
You may use the back of this page to provide additional well site details or well
abandonment details. You may also attach additional pages if necessary.
SUBMITTAL. INSTRUCTION$
10a. For Ali Wells: Submit this form within 30 days of completion of welt
abandonment to the following:
Division of Water Resources, information Processing Unit,
1617 Mail Service Center. Raleigh, NC 27699-1617
lob. Nrklitetion Wells: In addition to sending the forts to the address in 10a
above. also submit one ropy of this form within 30 days of completion of well
abandonment to the following:
Division of Water Resources, Underground injection Control Program,
1636 Mail Service Center, Raleigh, NC 27699-1636
loc. For Water upolh & Iniection_Wgllg: In addition to sending the foams to the
address(es) above, also submit one copy of this form within 30 days of completion
of welt abandonment to the county health department of the county where
abandoned.

w 1.eY-t-0 0 4-'7' 6
MOVE YOUR ENVIRONMENT FORWARD
HRP ASSOCIATES ENGINEERING & ENVIRONMENTAL MANAGEMENT, PLLC
October 10, 2018
Ms. Shrista Shrestha
Hydrogeologist
North Carolina Department of Environmental Quality
512 North Salisbury Street
1636 Mail Service Center
Raleigh, NC 27699-1636
RE: NOTIFICATION OF INTENT (NOi) FORM
FORMER BLACK & DECKER SITE, 1758 FAYETTE STREET, ASHEBORO, NC
(HRP #SBD0027.RA)
Dear Ms. Shrestha:
Please find enclosed a completed form Notification of Intent (NOi) to Construct or Operate
Inject Wells (deemed Permitted GW Remediation NOi Rev. 8/28/2017) for the site referenced
above and a digital copy on CD. We are planning to inject permanganate at nine (9) Geoprobe
points starting on October 29, 2018.
If you have any questions or require additional information, please feel free to contact HRP at
[phone].
Sincerely,
Daniel E McDonnell, PG
Senior Project Manager
Attachment
copy: Kathryn Hinckley (Stanley Black and Decker)
HRP ASSOCIATES ENGINEERING & ENVIRONMENTAL MANAGEMENT. PU.C I !97 SCOTT SWAMP ROAD. FARMINGTON, CT 06032 ; -!( [phone] [phone]
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 1
North Carolina Department of Environmental Quality – Division of Water Resources

Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.

DATE: October 12 , 2018____ PERMIT NO. (to be filled in by DWR)

A. WELL TYPE TO BE CONSTRUCTED OR OPERATED

(1) Air Injection Well……………………………..…Complete sections B through F, K, N
(2) Aquifer Test Well……………………….………..Complete sections B through F, K, N
(3) Passive Injection System…………………..……..Complete sections B through F, H-N
(4) X 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: Business/Organization

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): Stanley Black & Decker/Kathryn Hinckley, EHS Director, Environmental Affairs
Mailing Address: 700 Stanley Drive
City: New Britain State: CT__ Zip Code: 060533 County: Hartford
Day Tele No.: 860-827-3972 Cell No.: 860-919-5541
EMAIL Address: [e-mail] Fax No.:
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. This form shall be submitted at least 2 WEEKS prior to injection.

AQUIFER TEST WELLS (15A NCAC 02C .0220)
These wells are used to inject uncontaminated fluid into an aquifer to determine aquifer hydraulic characteristics.

IN SITU REMEDIATION (15A NCAC 02C .0225) or TRACER WELLS (15A 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 (Note: Injection Event Records (IER) do not need to be
submitted for replacement of each sock used in ORC systems).

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.
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page 2
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: Frankie Staley
Company Name Schwarz & Schwarz
Mailing Address: 2201 N. Fayetteville St
City: Asheboro State: _NC__ Zip Code: 27203 County: Randolph
Day Tele No.: 336-672-2633 Cell No.: 336-302-0267
EMAIL Address: [e-mail] Fax No.:

E. PROJECT CONTACT (Typically Environmental Engineering Firm)

Name and Title: Daniel McDonnell Senior Project Manager
Company Name HRP Associates, Inc.
Mailing Address: 1327 Miller Rd, Suite D
City: Greenville State: _SC_ Zip Code: 29607 County: Greenville
Day Tele No.: 800-752-3922 Cell No.: 864-350-6431
EMAIL Address: [e-mail] Fax No.: 864-281-9846

F. PHYSICAL LOCATION OF WELL SITE

(1) Facility Name & Address: Former Black & Decker Site
1758 Fayetteville St
City: Asheboro County: Randolph Zip Code: 27205
(2) Geographic Coordinates: Latitude**: o ′ ″ or o.
Longitude**: o ′ ″ or o.
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: 800,000 square feet
Land surface area of inj. well network: 4,500 square feet (< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 0.6 (must be < 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. 8-28-2017 Page 3
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.
A potassium permanganate slurry will be injected under pressure at nine Geoprobe borings located in
the vicinity of a former degreaser inside the plant. The purpose of the injection is to reduce concentrations of
VOCs in groundwater in the area. A total volume of 45,000 pounds of permanganate will be injected over an
estimated seven day period. The remedial mechanism (in-situ chemical oxidation) is expected to last several
years. The goal is to lower concentrations to a level where groundwater discharging to the stream to the north
no longer results in exceedances of the surface water standard.

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 injectants can be found online at http://deq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/ground-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
(919-807-6496).

Injectant: Potassium Permanganate with water and an inorganic viscosifier
Volume of injectant: 45,000 pounds
Concentration at point of injection: no more than 16 lbs per gallon of water
Percent if in a mixture with other injectants: ~50% by weight

Injectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:

K. WELL CONSTRUCTION DATA

(1) Number of injection wells: 9 Proposed Existing (provide GW-1s)
(2) For Proposed wells or Existing wells not having GW-1s, 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

L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Begin injection on October 29, 2018. Complete injection by November 5, 2018
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 surface water sample will also be collected on a monthly basis from the nearest point in the
unnamed tributary to the north. Also, existing Monitoring Wells MW-6 and MW-l4D will be sampled
monthly for at least six months.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penally 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 offines 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 15A NCAC 02C 0200 Rules,"
Signature of Applicant ' nt or Type Full Name and Title 4E120,aSJ
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, 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.
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 fornn.
Please send this NOI electronically to Shristi.ShresthaAncdenr.gov AND one hard copy to:
DWR — WC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 8.28-20[7 Page 4

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SW-16 814816818812820822824810826808806Path: C:\GIS\Michael GIS\Asheboro GIS files\RAP 2018\Figure 3- Shallow GW Elevation Contours_OCT 17.mxdFigure 2Shallow GroundwaterElevation ContoursOctober 2017Former Black & Decker PlantAsheboro, North CarolinaHRP # SBD0021.RA
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MOVE YOUR ENVIRONMENT FORWARD
1327 MILLER ROAD
SUITED
GREENVILLE, SC 29607
[phone]
HRPASSOCIATES .COM
840830820810800790780770760AA'(0.234)(41.7)(2140)(6440)1001000100(41.7)(41.7)FIGURE NO.PROJECT NUMBER:
ISSUE DATE:
CROSS SECTION A-A'
FORMER BLACK AND DECKER PLANT
ASHEBORO, NORTH CAROLINA
SBD0013.RA
11/20/2014
REVIEWED BY:
DRAWN BY:
MJP
DML
SCM
DESIGNED BY:REVISIONS
NO.DATE 040' 80'
SHEET SIZE:
11"x17"
DRAWING NAME: H:\B\Black & Decker\Asheboro NC\Remedial Action\RI 2015 (SBD0013.RA)\CAD\Cross Sections.dwg LAYOUT: A-A PLOT DATE: Jan 12, 2017 - 12:13pm OPERATOR: BOB
HORIZONTAL SCALE05' 10'VERTICAL SCALE3LEGEND r · -_-· =---=:J -RED-LIGHT BROWN SILT, SAND, CLA Y I·.:·> ~ ". ··:·~1 -SAPROLITE I 1KcS1J -PARTIALL r WEATHERED ROCK P);.>5;>1-COMPETENT BEDROCK -------GROUNDWATER SURFACE -TC£ CONG. IN ug/f (OCT. 2016) -TC£ CONG. IN ug/f (MOST RECENT SAMPLE) MOVE YOUR ENVIRONMENT FORWARD 1327 MILLER ROAD SUITED GREENVILLE. SC 29607 [phone] HRPASSOCIATES.COM
Copyright 2007
rev. 07/17
form RX 1601
The information contained herein is accurate to the best of our knowledge. However, data, safety standards and government regulations
are subject to change; and the conditions of handling, use or misuse of the product are beyond our control. Carus Corporation makes
no warranty, either expressed or implied, including any warranties of merchantability and fitness for a particular purpose. Carus also
disclaims all liability for reliance on the completeness or confirming accuracy of any information included herein. Users should satisfy
themselves that they are aware of all current data relevant to their particular use(s).
Carus and Design is a registered service mark of Carus Corporation. RemOx® is a registered trademark of Carus Corporation. Responsible
Care® is a registered service mark of the American Chemistry Council.
CA S Re gistry No . 77 22 - 64 -7
E IN EC S No . 231 -7 60 -3 FACT SHEET
RemOx® S ISCO Reagent
SHIPPING CONTAINERS
DESCRIPTION
HANDLING, STORAGE, AND INCOMPATIBILITY
CHEMICAL/PHYSICAL DATA
SOLUBILITY IN DISTILLED WATER
REMEDIATION GRADE
RemOx® S ISCO reagent has been specifically manufactured for
environmental applications such as remediation of soils and associated
groundwater. This product can be used to degrade a variety of
contaminants including chlorinated solvents, polyaromatic hydrocarbons,
phenolics, organo-pesticides, and substituted aromatics. RemOx S is
shipped with a certificate of analysis to document assay and trace metals.
Assay
> 98.8% as KMnO4
Trace Metals
(see Table 1)
Formula KMnO4
Formula Weight 158.0 g/mol
Form Granular Crystalline
Specific Gravity
Solid 2.703 g/cm3
3% Solution 1.020 g/mL by weight, 20° C/ 4° C
Bulk Density Approximately 100 lb/ft3
Decomposition may start at 150° C/ 302° F
Temperature Solubility
°C °F g/L oz/gal
0 32 27.8 3.7
20 68 65.0 8.6
40 104 125.2 16.7
60 140 230.0 30.7
70 158 286.4 38.3
75 167 323.5 43.2
25 kg pail (55.12 lbs) net, with handle, made of high-density
polyethylene (HDPE), weighs 2.1 lbs (.95 kg). It is tapered to allow
nested storage of empty pails, stands approximately 15.6 inches (39.7
cm) high and has a maximum diameter of 12.3 inches (31.2 cm).
(Domestic and international)
150 kg drum (330.75 lbs) net, made of 12-gauge steel, weighs 25.3 lbs
(11.5 kg). It stands approximately 28.4 inches (72.2 cm) high and is
approximately 19.7 inches (50.0 cm) in diameter. (Domestic and
international)
907-kg FIBC (Flexible Intermediate Bulk Container) (2000-lb)
net, (UN13H4/Y/0909), made of woven plastic, coated with inner poly
liner. Dimensions are 30 inches (76.2 cm) high, 30 inches (76.2 cm) long,
and 48 in (121.9 cm) wide. The spout diamater is 14 inches (35.6 cm) and
extends 18 inches (45.7 cm) in length. (Domestic only)
1000-MT FIBC (Flexible Intermediate Bulk Container) (2205-lb)
net, made of woven plastic, coated with inner poly liner. Dimensions are
30 inches (76.2 cm) high, 30 inches (76.2 cm) long, and 48 inches (121.9
cm) wide. The spout diamater is 14 inches (35.6 cm) and extends 18
inches (45.7 cm) in length. (International only)
Special Packages will be considered upon request.
Packaging meets UN performance-oriented packaging
requirements.

Crystals or granules are dark purple with a metallic sheen, sometimes
with a dark bronze-like appearance. RemOx S has a sweetish, astringent
taste and is odorless.
Protect containers against physical damage. When handling RemOx S,
European Community (CE) approved respirators should be worn to avoid
irritation of, or damage to, mucous membranes. Eye protection should
also be worn when handling RemOx S as a solid or in solution.
Store in accordance with NFPA 30 requirements in the United States or
the European Fire Protection Association in Europe for Class II oxidizers.
Additional regulations in Europe are REACH (Regulation for Registration,
Evaluation, Authorisation and Restriction of Chemicals), and CLP
(Classification, Labeling, Packaging). REACH is a regulation that increases
the responsibility of the industry to manage the risks that the chemical
may pose. For REACH registration numbers refer to the eSDS. Check
local regulations to ensure proper storage.
RemOx S is stable and will keep indefinitely if stored in a cool, dry area in
closed containers. Concrete floors are preferred to wooden decks. To
clean up spills and leaks, follow the steps recommended in the SDS or
eSDS. Be sure to use goggles, rubber gloves, and respirator when cleaning
up a spill or leak.
SHIPPING CONTAINERS
CORPORATE HEADQUARTERS | 315 Fifth Street, Peru IL 61354 | Tel [phone] | Fax [phone] | Web: www.caruscorporation.com | E-mail: [e-mail]
CARUS EUROPE | Calle Rosal 4, 1-B | Oviedo, Spain 33009 | Tel +34.985.785.513 / Fax +34.985.785.510
CARLIS
REMEDIATION
CARUS CORPORATION ONE COMPANY. ENDLESS SOLUTIONS
c::;:......,.F'<.LJS "'
CA S Re gistry No . 77 22 - 64 -7
E IN EC S No . 231 -7 60 -3 FACT SHEET
RemOx® S ISCO Reagent
SHIPPING
Avoid contact with acids, peroxides, and all combustible organic or
readily oxidizable materials including inorganic oxidizable materials and
metal powders. With hydrochloric acid, chlorine gas is liberated.
RemOx® S ISCO reagent is not combustible, but it will support
combustion. It may decompose if exposed to intense heat. Fires may be
controlled and extinguished by using large quantities of water. Refer to
the SDS or eSDS for more information.
RemOx S is classified by the Hazardous Materials Transportation Board
(HMTB) and The European Agreement concerning the International
Carriage of Dangerous Goods by Road (ADR), as an oxidizer. It is
shipped under Interstate Commerce Commission’s (ICC) Tariff 19.
Proper Shipping Name: Potassium Permanganate
(RQ-100/45.4)
Hazard Class: Oxidizer, Class 5.1
Identification Number: UN 1490
Division/ADR/RID Class: 5.1
Label Requirements: Oxidizer, 5.1
Packaging Group: II
Packaging Requirements: 49 CFR Parts 100 to 199
Sections: 173.152, 173.153, 173.194
Shipping Limitations:
Minimum quantities:
Rail car: See Tariff for destination
Truck: No minimum
H.S. Code 28.41.61.00
Postal regulations:
Information applicable to packaging of oxidizers for shipment by the U.S.
Postal Service to domestic and foreign destinations is readily available
from the local postmaster. United Parcel Service accepts 25 lbs (11.3 kg)
as largest unit quantity properly packaged; (consult United Parcel Service).
According to ADR Regulation, transportation should not exceed 1.1.3.6.
LIMITS, transport category 2, maximum authorized per transport unit,
333 kg. Regulations concerning shipping and packing should be consulted
regularly due to frequent changes.
RemOx S is compatible with many metals and synthetic materials. Natural
rubbers and fibers are often incompatible. Solution pH and temperature
are also important factors. The material must be compatible with either
the acid or alkali also being used.
In neutral and alkaline solutions, RemOx S is not corrosive to iron, mild
steel, or stainless steel; however, chloride corrosion of metals may be
accelerated when an oxidant such as permanganate is present in solution.
Plastics such as polypropylene, polyvinyl chloride Type I (PVC I), epoxy
resins, fiberglass reinforced plastic (FRP), Penton, Lucite, Viton A, and
Hypalon are suitable. Teflon FEP and TFE, and Tefzel ETFE are best. Refer
to Material Compatibility Chart.
Aluminum, zinc, copper, lead, and alloys containing these metals may be
(slightly) affected by RemOx S solutions. Actual studies should be made
under the conditions in which permanganate will be used.
Element
Typical
Analysis
(mg/kg)
Specifications
(mg/kg)
DL*
(mg/kg) Element
Typical
Analysis
(mg/kg)
Specifications
(mg/kg)
DL*
(mg/kg)
Ag BDL 0.40 0.048 Hg BDL 0.05 0.004
Al 55.85 115.00 0.28 Na 228.03 750 0.069
As 0.04 4.00 0.006 Ni 0.78 5.00 0.048
Ba 10.60 50.00 0.016 Pb BDL 1.00 0.20
Be BDL 0.50 0.10 Sb BDL 1.00 0.20
Cd BDL 0.10 0.02 Se BDL 1.00 0.002
Cr 1.60 7.50 0.028 Tl BDL 5.00 1.00
Cu 0.15 3.00 0.034 Zn 0.87 6.00 0.016
Fe 0.22 100.00 0.066

DL* = Detection limit BDL = Below detection limit
Table 1: Typical Trace Metal Content and Specifications
HANDLING, STORAGE, AND INCOMPATIBILITY
SHIPPING
CORROSIVE PROPERTIES
Copyright 2007
rev. 07/17
form RX 1601
The information contained herein is accurate to the best of our knowledge. However, data, safety standards and government regulations
are subject to change; and the conditions of handling, use or misuse of the product are beyond our control. Carus Corporation makes
no warranty, either expressed or implied, including any warranties of merchantability and fitness for a particular purpose. Carus also
disclaims all liability for reliance on the completeness or confirming accuracy of any information included herein. Users should satisfy
themselves that they are aware of all current data relevant to their particular use(s).
Carus and Design is a registered service mark of Carus Corporation. RemOx® is a registered trademark of Carus Corporation. Responsible
Care® is a registered service mark of the American Chemistry Council.
CORPORATE HEADQUARTERS | 315 Fifth Street, Peru IL 61354 | Tel [phone] | Fax [phone] | Web: www.caruscorporation.com | E-mail: [e-mail]
CARUS EUROPE | Calle Rosal 4, 1-B | Oviedo, Spain 33009 | Tel +34.985.785.513 / Fax +34.985.785.510
CARLIS
REMEDIATION
CARUS CORPORATION ONE COMPANY. ENDLESS SOLUTIONS
c::;:......,.F'<.LJS "'
AGREEMENT REGARDING SUPPLEMENT AL
CONDITIONS OF ACCESS TO PROPERTY
This AGREEMENT REGARDING SUPPLEMENTAL CONDITIONS OF ACCESS
TO PROPERTY ("Agreement") is made and entered into this_ day of ______ ,, 2013
(the "Effective Date"), by and between SCHWARZ & SCHWARZ, LLC ("S&S"), and
STANLEY BLACK & DECKER, Inc. ("Stanley") (collectively, the "Parties").
RECITALS
A. S&S is the current owner of approximately 54 acres of real property located at 1758
South Fayetteville Street, Asheboro, North Carolina, as more fully described in Deed
Book 1692, pages 0505 to 0508 in the Randolph County Deed Book (the "Property").
S&S's predecessor in interest, Schwarz & Schwarz, Inc., acquired the Property from
Stanley's predecessor in interest, Black & Decker, Inc.
B. Pursuant to the "Declaration of Rights and Restrictions" at Deed Book 1692, pages 0505
to 0508 (the "Deed") (attached hereto as Exhibit A), Stanley is performing certain
remediation work with respect to contamination at the Property, including volatile
organic compounds ("VOCs") in groundwater. Stanley is conducting the remediation
process in conjunction with the North Carolina Department of Environment and Natural
Resources ("DENR"). Stanley will continue the remediation process until the
concentrations of contamination at the Property are sufficient to obtain a No Further
Action Letter ("NF A Letter").
C. Stanley currently monitors approximately twenty-one (21) groundwater and surface
water monitoring wells at the Property on a semi-annual basis. Stanley monitors these
wells for concentrations of VOCs. In an effort to better understand the extent and
nature of the contamination at the Property, Stanley plans to implement a soil gas survey
that will require the use of soil gas vapor monitoring points and the installation of
additional groundwater monitoring wells, pursuant to the Scope of Services (attached
hereto as Exhibit B) prepared by HRP Associates, Inc. ("HRP").
D. The Deed grants Stanley, its agents, consultants, contractors, and subcontractors a
license permitting them to access the Property for the purpose of any and all
remediation work and/or other work which may be necessary and proper in connection
with contamination at the Property (the "Work"). This license runs with the Property
and is to remain in place until the concentrations of contamination at the Property are
sufficient to obtain a NF A Letter.
E. The Parties wish to enter into this Agreement to provide for certain supplemental
conditions of Stanley's access to the Property that are not otherwise directly addressed in
the Deed.
NOW, THEREFORE, for and in consideration of the mutual promises and covenants set
forth herein, and other good and valuable consideration, the receipt and sufficiency of which is
hereby acknowledged, the Parties agree as follows:
1. Conditions of Access. Stanley shall provide S&S with written notice at least
three (3) business days in advance of each entry onto the Property ( each entry is known as an
"Access Event"). S&S and Stanley shall use good faith efforts to work cooperatively in
coordinating times and methods for such Access Events. Stanley shall conduct all work in such
a manner as to avoid unreasonable disruptions to the ongoing operations of the tenants on the
Property. If S&S determines in its sole discretion that any of the Work may result in an
unreasonable disruption to ongoing operations of tenants on the Property then Stanley shall use
its best efforts to relocate that section of the Work to a new location mutually agreed upon by
the Parties.
2. Standards of Performance. Stanley will ensure that all Work is performed
in accordance with the generally accepted standards practiced by reputable professionals in the
environmental consulting, engineering and remediation professions. Stanley will further
ensure that all Work is performed in compliance with all applicable laws and regulations, and
that all required permits and authorizations are obtained prior to initiating any activities
requiring such permits and authorizations.
3. Responsibility for Costs. Stanley shall be responsible for all costs and fees
associated with or arising from the Work. In the event that any of the Work results in any
unreasonable disruption or damage to the Property, Stanley will, at its expense, restore the
Property to the same condition as existed immediately preceding such activity and assume all
responsibility for costs or fees incurred by tenants of the Property for the unreasonable
disruption to their operations including but not limited to any reasonable business interruption
claims.
4. Copies of Reports. Stanley shall promptly provide S&S with copies of all
technical reports and data collected by Stanley during the Work and all correspondence to and
from DENR concerning the Work.
5. Waste Materials. Stanley agrees that all materials generated during the Work,
including without limitation investigation derived wastes, are Stanley's sole responsibility.
Stanley will ensure that such materials are removed from the Property immediately after each
Access Event and handled and disposed of in accordance with all applicable laws and
regulations. It is not anticipated that any waste materials will be stored on the Property. To the
extent that it becomes necessary to store any materials on the Property, Stanley shall obtain the
prior approval of S&S as to the location of any storage sites. Moreover, Stanley shall comply
with all federal, state and local laws regarding the storage of any materials including but not
limited to waste materials. In no event shall Stanley store on the Property any materials or
waste for longer than thirty (30) days.
6. Insurance. Stanley shall ensure HRP and any other contractors or
subcontractors of Stanley which enter the Property maintain the following insurance
coverages: workers compensation insurance (applicable statutory requirements), commercial
general liability insurance ($1 million per occurrence and $5 million aggregate), professional
liability insurance ($1 million per occurrence and $5 million aggregate), umbrella/excess
insurance ($5 million), name S&S and its predecessor Schwarz & Schwarz, Inc. as an
2
additional insured on all such policies and, on request, provide a certificate of insurance
showing the same.
7. Monitoring Well Closure. Stanley shall at its expense remove and abandon,
in accordance with all applicable laws and regulations and, to the extent possible, restore the
Property to the same condition as existed immediately preceding such activity, the groundwater
and surface water monitoring wells and any related, piping, lines and equipment within thirty
(30) days after termination of this Agreement.
8. Liability/Indemnification. Excepting those caused by the negligence or
omission of S&S and/or its parent, subsidiaries and affiliates and each of their respective
members, tenants, managers, officers, directors, employees, agents, successors and assigns (the
"S&S Parties"), Stanley shall indemnify, defend and hold harmless the S&S Parties from and
against any claim, liability, notice, fines, penalties, expense, loss, cost or damage whatsoever
(including without limitation reasonable legal, accounting, engineering, or consulting fees) for:
(a) the VOC contamination located at the Property as detailed in the Deed and the
2005 Clean-up Plan and Report (attached hereto as Exhibit C);
(b) any additional VOC contamination that is discovered as a result of the sampling
and analysis to be undertaken pursuant to the Scope of Services prepared by HRP;
(c) any act or omission of Stanley, HRP or their respective representatives, agents,
employees, contractors or subcontractors in connection with the Work or their entry
onto the Property; and
(d) Stanley's violation of this Agreement.
9. Termination.
This Agreement shall terminate upon DENR's issuance of an NF A Letter to Stanley
with respect to the contamination at the Property for which Stanley is responsible. The
obligations of Stanley under Sections 8 of this Agreement shall survive termination of this
Agreement indefinitely.
10. Notices. All notices required or made under this Agreement shall be in writing
and shall be sent by certified mail, postage prepaid, return receipt requested, or shall be hand
delivered or delivered by a recognized national overnight courier service, addressed as follows:
3
To S&S:
2201 N. Fayetteville Street
Asheboro, NC 27203
To Stanley:
Kathryn E. Hinckley,
EHS Director, Environmental Affairs
Stanley Black & Decker
1000 Stanley Drive
New Britain, CT 06053
With copy to:
Nathan Hunt
Thompson Hine LLP
Austin Landing I, 10050 Innovation Drive
Suite 400
Miamisburg, OH 45342A934
Either Party may change the above designations by written notice to the other Party.
11. Binding Effect. This Agreement shall be binding upon and enure to the benefit
of the Parties and their successors, and assigns.
12. Modifications . This Agreement may be modified only by mutual consent in
writing, signed on behalf of the parties hereto.
13. No Admission. The parties agree that this Agreement is not in any manner, nor
shall it constitute, an admission of any fact, circumstance or liability.
14. Governing Law. This Agreement shall be governed by the laws of the State
of North Carolina without regard to its conflict of laws principles.
15. Separate Counterparts. This Agreement may be executed in separate
counterparts, each of which shall constitute an original. This Agreement may also be executed
by .pdf or facsimile copies, and will be effective upon such execution. In the case of .pdf or
facsimile signatures, the Parties agree to exchange original signatures as soon as practicable
thereafter.
16. Entire Agreement. This Agreement constitutes the entire agreement between
the Parties regarding the supplemental conditions of Stanley's access to the Property that are not
otherwise directly addressed in the Deed. Nothing herein is intended by the Parties to
supersede; modify, or terminate the "Declaration of Rights and Restrictions" contained in the
Deed.
4
17. Severability. The invalidity or unenforceability of any provisions or portion
thereof of this Agreement shall not affect the validity or enforceability of any other provision
or part thereof.
IN WITNESS WHEREOF, the Parties have made and executed this Agreement as of
the Effective Date.
SCHWARZ & SCHWARZ, LLC
By:~~~
Title: ,::. ►• C d'.'.l-0
STANLEY BLACK & DECKER, INC.
By:---------------
Title: ----------------
s
17. Severability. The invalidity or unenforceability of any provisions or portion
thereof of this Agreement shall not affect the validity or enforceability of any other provision
or part thereof.
IN WITNESS WHEREOF, the Parties have made and executed this Agreement as of
the Effective Date.
SCHWARZ & SCHWARZ, LLC
By:. ____________ _
Title: -------------
STANLEY BLACK & DECKER, INC.
By:~l{~(/~
Title: E\:\-5 J)\rerrct EO\/\foOf'l"NI:~ Mai~ '
5
Exhibit A
Excise Tax $4,750.00
FILED 20e43-026646
Dec 28 28180 12:37:55 ps
Randolph County, NC
Ann Shaw, RESISTER of DEED
Recording Fee 14.@0
NC Real Estate ExTx4750. 00
Recording Time, Rock and Page
Tax Lot No.
Verified by
by
Parcel Iderttificr No.
County on the day of
20,
lvtiulafter recording to jSchwarz & Schwarz, Inc., P.O. Box 1104 Asheboro, NC 27204
IT„s lusLwrx-rt vras prcpmrd by Roburson, Bradshaw & Hinson, A. (CQF, fr.)
Brief desorption for the 1ndcx
Approximately 54 Acres at 1758 South Fayetteville
Street, Asheboro, North Carolina
NORTH CAROLINA SPECIAL WARRANTY DEED
THIS DEED made this 2 7 t t clay of December
, 20 00 , by and betweer.
GRANTOR
/LACK & DECKER (U.S.), INC., a
Maryland corperaaon
1701 fast Joppa Road
Towson, Maryland 21286
Auention Mr- Jack Gaylord
GRANTEE
SCHWARZ& SCHWARZ, INC., a
North Caroluta corporation
PO.Box 1104
Asheboro, North Carolina 27204
Enter In appropriate block for each party: name, address, and, if appropriate, character of entity, c.q. corporation •r partnership,
The designation Grantor and Grantee as used herein shall include said parties, their heirs, summers, and assigns, and shall include
singular, plural, masculine, feminine or neuter as required by context.
WITNESSET'f-1, that the Grantor, for a valuab'e consideration paid by the Grantee, the receipt of which is hereby
acknowledged, has and by these presents do grant, bargain, sell and convey to the Grantee in fee simple, all that certain lot or parcel
cif land situated in the City of Asheboro, Randolph County, North Carolina and more particularly descnbed as being all of the property
conveyed to Grantor by that certain deed to Grantor from General Electric Company dated April 27. 1984 and tiled for record April
30, 1984 in Book 1151 at Page 881 in the Randolph County Public Registry (which deed is incorporated into and made part of this
Deed by this reference), LESS AND EXCE:Vt AND EXCLUDING from the conveyance by this deteL so much of the property
described in the aforesaid deed from General Electric Company to Grantor andfor any interest therein, if any, as Grantor shall have
heretofore conveyed to others

eta
The property described abuve is hereinafter (ailed the "Property" "Declarant" shall mean Grantor and its successors from
tittle 10 timee aria the term "Owner" shall mean Grantee and its successors from time to time in ownership of the Property. "Covered
Hazardous Substances" means: the groundwater contaminated by trichloroethene; 1,1-dich1omethene, 1,1,1 trichloroethane;
tetrachloreethene. cis-1,2 dithloroethene: 1,2 dichloroethanc, and chloroform identified by and in the immediate vreinity of
:monitoring wells MW-2, MW-3, MW•5 and MW-6, as depicted on Figure 1 of the Notification of Groundwater Conditions dated
3/16/99 and identified in March 16. 1999 levier of Roy F. Weston, Inc to Ms. Sherri V Krught from William C. Morris, P G which is
made pan of this Deed by this reference.
Declaration of Rtaits and Restrictions
Grantor, as Declarant, for the use and benefit of itself, its successors and assigns, does hereby declare. encumber. place and
impose upon the Property to enable Declarant to perform certain remcdiatio❑ work in respect of the Covered Hazardous Substances on
the Property and to protect Declarant from liability which may arise out of any inability to perform that work, any interference with or
change to that work and any change in the use of the Property. Pursuant to the Purchase and Sale Agreement dated as of November
21, 2000 between Declarant and Grantee, Declarant is obligated to perform certain remediation work in respect of the Covered
Hazardous Substances as may be required by the North (2arolina Department of Ernirottment and Natural Resources ("DENR".) for the
continued use 5f the Property as an industral facility This declaration ("Declaration") is intended to nomplimcnt and supplement
governmental laws and regulations and in the event of a conflict occurring between the previsions of this Declaration and each laws
and regulations, the most stringent requirements shall control.
THEREFORE, in consideration of the preinses and of the mutual benefits and duties herein contained, Declarant hereby
declares and Grantee. by es acceptance of this Deed, hereby agrees that the Property shall be held• sold and conveyed subject to the
following covenants, reservations, licenses, conditions and restrictions, all of which are for the purposes stated above, and which shall
burden and run with the title to the Property for the benefit of Declarant and shall be binding on Owner and all parties having any
right, title or interest m the feoparty and Declarant. and their heirs, successors and assigns, and wt1ic11 shall inure to the benefit of each
owner thereof:
(i) a license permitting Declarant and its agents, consultants, contractors and subcontractors ingress, egress and regress
over and upon the Property for the purpose of any and all retnediation work and/or other work which may be
necesCary or proper in cosmeelion with any Covered Hazardous Substance, and
(hi) a restrictive covenant in favor of Declarant and prohibiting Grantee and all Owners and its and their successor and
assigns having any right or interest in respet:t of Ilse Property from using any portion of the Property affected by the
Covered Hazardous Substances far any purpose other than industrial uses; and
(iii) a restrictive covenant in favor of Declarant and prohibiting Grantee all Owners and its and their successor and
assigns having any right or interest in respect of the Property from interfering with and/or in any manner making any
:liattge to arty =mediation work or equipment or device performed and/or installed on the Property by or for
Declarant and which may be necessary or proper in connection with the Covered Hazardous Substances.
The license described in item (i) above shall automatically expire and terminate at such time as DENR shall have fully and
finally released Declarant from all obligations and liability, (for remediation or otherwise) in respect of the Covered
Hazardous Substances Seller shall execute and deliver to thvver an instillment tb recordable form and terminating the
license described in item (i) above at such time DENR shall have fully and finally released Declarant frown all obligarons and
liability (for rcmcdiation or otherwise) in respect of the Covered Iazardous Substances_
Any agent or contractor of Der:laratd may, al any reasonable time or times after reasonable notice, enter upon and inspect the
Property for the porpoise of ascertaining whether the Property and the use or uses conducted thereon arc m compliartm with the
provisions of this Declaration and neither Declarant nor any such agent of either, shall he deemed to have committed a trespass or
other wrongful act by reason of such entry inspection.
Any notice required or permitted to be given hereunder shall be in writing and shall be deemed to have been given when
delivered personally to Grantor or to Grantee at its address set forth above or when deposited in the United States mail, postage pre-
paid, certified or registered mail, tetunt receipt requested and addressed to Grantor or Grantee at its address set forth above. Each of
Grantor and Grantee and its successors and assigns shall have the right to change its address for notices by giving written notice of
such change to the other ur the foregoing manner_
General Provisions
Duration; Modiffctttiun or'Farmirtation. The provisions of this Declaration shall be appurtenant to and run with the title to
the Property and shall be binding upon Declarant, Grantee and all Owners, their heirs. successors and assigns, and all other parties
hereinafter having an interest in any of the Property and all parties claiming under them without further notice, and without limitation
unless modified or terminated as hereinafter provided
This Declaration may be modified by the recording in the Registry of an agreement of modification executed by Declanrnl
and the Owner For purposes of this Section, "Owner' shall not include any owner or holder of a reversionary interest in all or any
portion of the Property under lease with a term in excess of thirty (30) years
r.e890rnm rliOi.DSO ;d P5.0Lh
2

Enforcement. This Declaration may be enforced by Declarant and ila successors and assigns by proceedings at law or in
equity against any person. firm or other entity violating or attempting to violate any covenant or covenants or other provisions of this
Declaration, either to restrain the violation thereof or to recover damages together with reasonable attorneys' fees and court costs.
Partial Invalidity. Any i ivalidation of any cnc or more of the provisions of this Declaration by judgment, court order or
statute or failure on the part of Declarant or its successors or assigns to enforce any of such provisions shall in no way affect any of the
other provisions hereof or be deemed as a waiver of the right to enforce such provisions any time after the violation thereof
Bin4iae k'ffect; Waiyet. Except as otherwise specifically provided herein, this Declaration shall bind Grantee, each Owner
and the Property and shall inure to the benefit of and be enforceable by the Declarant. The failure of any person or entity so entitled
to enforce this Declaration or any provision thereof shalt not be deemed a waiver of the right of any such person or entity to errforcc
this Declaration or any portion thereof thereafter Waiver or any attempt of waiver of this Declaration with respect any violation shall
not be deemed a waiver thereof as to any subsequent violation_
Suecessere. The term "Declarant.' as used herein includes all successors and assigns of Declarant The term "Owner' as
used herein includes ail successors and assigns of Grantee in ownership of the Property.
Chafe of 'title. Each grantee. lessee or other person in interest or occupancy accepting a conveyance. leasehold interest or
other den -use of an interest uo or to or in connection with the Property, whether or net the same incorporates or refers to this
Declaration, covenants for itself, and its heirs, successors and assigns to observe and perform and be bound by this Declaration and to
incorporate this Declaration by reference in any conveyance or leasehold estate of all ur any portion of its interest in any real property
subject to this Declaration.
No Reversionary Interest. The provisions of this Dcclaration shall not be construed as conditions subsequent, or creating a
possibility of reverter, and no provision hereof shall be deemed to vest in the Declarant or any other persons any reversionary interests
with respect to the Property. All reversionary rights sre hereby expressly waived by Declarant.
Zoning Requirements. This Declaration shall not be interpreted as permitting any action or thing prohibited by applicable
zoning laws, or any laws, oniinances or regulations of any governmental authority or by specific restrictions imposed by any deed or
other conveyance. In the event of any conflict, the most restrictive provision of the same shall be taken to govern and control_
Exoneration of I/eclarxat. Each Owner of the Property or any other party interested in the Property expressly agrees that no
duty or obligation is imposed upon Declarant to enforce or attempt to enforce any of the covenants or restrictions contained herein, nor
shall Declarant be subject to any liability of any kind or nature whatsoever from any third party from failing to enforce same.
TO HAVE AND TO HOLD the aforesaid Property and all privileges and appurtenances thereto belonging to the Grantee in
fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair such title as Grantor received, and
Grantor will warrant and defend the title against the lawful claims of all persons claiming by, under or through Grantor, except for the
exceptions hereinafter stated.
ois
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Title to the Property hereinabove described is subject to the following exceptions
1. Ad valorem real properly taxes for 2000 and subsequent years.
2. The leases assigned by Grantor to Grantee and any matter of title which exists of record as of the November 2 I.
2000 other than and except Monetary Lens; and the license and restrictive covenants provided for in this Deed.
eatanetary Liens" shall mean, any and all liens or claims for deferred or "rollback" taxes a sdlor taxes other than
those to be prurated AI Closing, and all mortgages, deeds of trust, deeds to secure debt or other debt security
instruments, and all attachments, judgments, mechanic's or Irtatcralmen's liens, and any office lien or encumbrance
of a definite or ascertautable amount which may be removed by the payment of money, provided, however, it is the
intent of Grantor and Grantee, that any restrictive covenant which has expired or is otherwise not enforceable, shall
hereafter remain unenforceable and shall not be reinstated in any manner hereby.
3 The rights, reservations and covenants set forth in this Deal.
.:I9(11v0I I;20191i10 r1GCLs
'Remainder of page lett blank intentionally]

RE BOOR Book s 1692
Page: lasea
IN WITNESS WHEREOF, the Grantor has hereunto set his instrument and scat, or if corporate, has caused this instrent to be
signed in its corporate name by its duly authorized officers and its seal to be hereunto affixed by authority of its Board of Directors.
the day and year Gras above written.
•
a
STATE OF MARYLAND - - r ' '('
I, a Notary Pabtia of the County end Stele sfaresaid. certify that .) K ti r Yi 0 141 f t , t ::•
personalty ama before Inv this day end uknuwledgad that ha urelfa is ve r :...11;;;:aeHry of BLACK a
ASECKE (U.&), INC'., a rn� r a ' neporatioa, and that by authority duly given and m uav as of Useryrwat oolion. I t fbrentong inNumert une ngned In na nann by du 1/ 4 Plraide t•'sailed wi b its oorplaata
soot and elicited by Oa •t r aarn6tary.
Witness my hand and Maid soot, this 2• 7 dry of :i c.c., ' a 2000
My communion splices, 5// /t �.._.. 1 ` 111.. Notary Public
Tlac forettotn a Certificate f s' of
NORTH CAROLINA — RANDOLPH COUNTY
The foregoing ccrtifirate(s) of
Notary/Notaries Public is/arc certified correct- be)
AOQQ
This �+�, day of
ANN SHAV,y, REGISTER Oi ADF.EDS
by:
C411116rr,m i l 7016IQ16 rescuer
4
1:4111:t
Register of De

Exhibit B
I. SCOPE OF WORK
TASK 1: Soil Gas Assessment
Soil gas surveys will be performed 1) at specific locations along the buildings' peripheral, and 2)
in a uniform grid pattern in the central and western portions of the property. The purpose of the
soil gas assessments are to determine optimum locations for monitoring wells and delineate
areas of concern. Soil gas samples will be obtained via two (2) methods: summa canisters and
passive samplers.
Summa canister samples will require the installation of temporary vapor monitoring points
(VMPs)(Figure 1). A Geoprobe will be utilized to direct-push a soil gas screening point to a
target depth (-5 to 10 feet below grade depending on groundwater elevation). The 6-inch long
soil gas screen point will be connected to a surface valve with 1/4-inch polyethylene tubing. The
VMP boring will be completed with a sand-pack surrounding the screen point and sealed to the
surface with bentonite/grout. The VMPs will be protected with metal flush-mount vaults.
A summa canister will be attached to the VMP hose-barb using dedicated tubing following
purging of the system. In order to collect a sample, the ball-value on the VMP will be opened
first, and then the gate-valve on the canister will be opened. Field data, such as time of
sample collection initiation and completion, vacuum gauge readings, etc., will be recorded by
an HRP geologist. Upon receipt of the summa canister analytical results, detected
concentrations will be compared to the acceptable soil gas concentration screening criteria
set forth in the January 2012 IHSB Screening Table.
The passive soil gas survey will utilize adsorbent samplers that are emplaced subsurface to
adsorb constituents in soil gas without forcing the flow rate of gas, thus yielding a more
representative sample than active soil gas methods. The passive samplers will be installed
through asphalt or concrete surfacing by drilling a 1.25 to 1.5-inch diameter hole to the
underlying soils, and then a 1/2" to l" diameter drill bit is used to extend the hole to a three
foot depth. The sampler is installed inside the hole, and then the top of the hole is patched
with an aluminum foil plug and a thin concrete patch to protect the sampler, and allow
vehicles to move freely throughout the survey area.
The passive samplers will be installed in a uniform grid pattern with SO-foot to 100-foot
spacing between points depending on location. The samplers will be exposed to subsurface
gas for approximately 14 days. Following the exposure period, the samplers are retrieved
and shipped to a lab for analysis.
The analysis of the soil gas shall be limited to volatile organic compounds (VOCs). The scope of
analysis shall be identical to the groundwater analysis performed at the site.
TASK 2: Delineation & Bedrock Characterization
Four (4) shallow monitoring wells will be installed in the southeast and southwest portions of
the Site for the purpose of horizontal delineation of groundwater constituents (Figure 1). ln
addition, one (I) transition zone well and five (5) deep aquifer monitoring wells will be
installed down-gradient of the two (2) former degreaser source areas fo r the purpose of a)
vertical delineation and b) obtaining data required to complete a Site conceptual model.
{#1578862-1 . 108799-00000-01}
The anticipated screened intervals of the proposed shallow wells will be consistent with
historical Site data. The deep wells will be installed 10 to 15 feet into competent rock
(estimated range of 25 to 49 feet bel ow ground surface in previous
investigations). All monitoring wells will be installed in accordance with NCDENR
permits and applicable well regu lations.
Shallow monitoring wells will comprise 2-inch diameter schedu l e 40 flush-
threaded PVC casing with five (5) to ten (10) feet of 0.010-inch slotted screen.
Deep aquifer wells will comprise a surficial 8-inch diameter PVC casing from the
ground surface to 2 feet into bedrock (i.e. rock socket). Deep wells will be cored
with an HQ core barrel which will create an open interval diameter of approximately
4-inches. All wells will be completed at the surface with a flush-to-grade bolt-down
vault box set in a cement pad.
Groundwater Sampling
New monitoring wells will be sampled approximately one (I) week following
installation and developed in accordance with the U.S. Environmental Protection
Agency (EPA) Region 4 Science and Ecosystem Support Divi s ion (SES D )
Operation Procedure for Groundwater Sampling (SESDPROC-301-R I, November
I, 2007). In order to collect a groundwater sample representative of the aquifer,
purging will be conducted prior to sample collection with a submersible stainless
steel electric pump. A l o w-flow/low-volume method of purging will be employed to
limit disturbance to the water column and to reduce the volume of purge water
generated. Water quality parameters will be monitored at discrete volume intervals
similar to well development. The purging of the well will be considered complete
once stabilization occurs as defined in SESDPROC-301-R 1.
Groundwater Laboratory Analysis
Once purging is completed, groundwater samples will be collected in lab oratory
supplied containers and submitted to a certified North Carolina laboratory for the
analysis of volatile organic compounds (VOCs) via EPA Method 8260. Except for
the geotechnical parameters discussed below , the scope and type of analysis
conducted will be identical to those previously conducted on site by HRP.
Geochemical parameters will also be collected from newly ins talled wells to assess
localized aquifer conditions (e.g. dissolved oxygen (DO), oxidation reduction
potential (ORP), ferrous iron, total/dissolved iron, nitrate, sulfate, and total /disso lve d
manganese). Groundwater samples will be preserved on ice in the field and submitt ed
under chain of custody to the laboratory.
Disposal of Investigation Derived Waste
Soil cuttings produced during the installation of the monitoring wells w i ll be contained
in 55-gallon drums and temporarily staged at an approved on-site location until
proper disposal is coordinated. ln similar fashion, all well development/purging fluids
will be contained in 55-gallon drums and staged in the aforementioned area.
TASK 3: Site Elevation Survey
{111578862· I, I 08799-00000-0 1 }
All VMPs and monitoring wells (existing and newly installed) will be surveyed by a
North Carolina certified surveyor following the completion of the investigations.
This survey will provide an updated base map which will be incorporated into
all site figures (i.e., groundwater flow paths and concentrations maps).
TASK 4: Data Analysis and Investigation Report
HRP will analyze all data collected during the aforementioned investigations and generate a
comprehensive report. This document will incorporate all methodo log ies, results and
conclusions of the investigations. The repo rt will be produced in a format consistent with
NCDENR IHSB guidelines and submitted to SB&D for comment and review. Schwarz and
Schwarz shall be provided any report that is submitted to NCDENR at least 24 hours before the
report is submitted to NCDENR.
{#1578862-1, 108799-00000-01}
PROPOSED INJECTION WELL CONSTRUCTION DATA
Former Black & Decker Site, Asheboro, NC
(North Area of Concern)
WELL TYPE: Geoprobe (Temporary) ‐ No casing left behind
NUMBER OF WELLS: Nine ‐ all with same construction
TOTAL DEPTH BELOW LAND SURFACE: Approximately 40 feet
INJECTION INTERVALS: Five per Boring, starting at ~20' (depth to water table)
WELL CONTRACTOR NAME/CERTIFICATION NUMBER: TBD
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 15 CAC l)2C .()2()(). This [orm shall be !iubmiltetl at least 2 WEEKS prior lo 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 S/TUREMEDIATION (ISA NCAC 02C .0225) or TRACER WELLS (15A NCAC 02C .0229):
1) Pa s ive In jec ti o n ys te m -In-well delivery systems to diffuse injectants into the subsurface. Examples include
ORC socks , iSOC systems, and other gas infu s ion methods.
2) Sma ll-ca le Inj ec ti on O pe rat io ns -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) A ir l nj ct io n Well s -Used to inject ambient air to enhance in-situ treatment of soil or groundwater .
Print Clearly or Type Information. Illegible Submittals Will Be Retumed As Incomplete.
DATE :-----~· 20 PERMIT NO. ________ (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERA TED
(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
XXXX Small-Scale Injection Operation ...................... Complete sections B through N
___ Pilot Test. ................................................ Complete sections B through N
___ Tracer Injection Well. .................................. Complete sections B through N
B. STATUS OF WELL OWNER: C hnose an itein.
C. WELL OWNER(S) -State name of Business/Agency, and Name and Title of person delegated authority to
sign on behalf of the busine ss or agency :
Name( s): __ ....,Nc..:...:::C'---=D-=e""pa:::rt..:.:m=en'-"t'-'o"--'f'--'-A-"d~m=i n.:..:.is""'t"'-'ra=t"-"io""n,_,{"""U'""S"--'T,_,_,ln=c=id=e=n=t-'-'-#-=3=3'-"-9-=-3_,___I .,_) ---=c-'-'/o"----'--'-M=r.,__. ""'R=o=be=rt'-"---"T-=a=ll-=-ev ___
Mailing Address: __ __,l"""l-"'6_W'-'-"-e""'st'---"J'""o_,__,n=es"---S=t,,,_re.:.;e::..:t __________________ _
City : Raleigh State : NC Zip Code : 27603 County : WAKE
Day Tele No.: 919-807-4125 Cell No .: 919-358-3543
EMA IL Address: Rob en.ta ll ey @doa.nc.gov
Dee med Pennitted GW Remediation NO i Rev .6/1/20 17
Fax No.: --~N~A~_
Page I
D. PROPERTY OWNER(S) (if different than well owner)
Name and Title:
Company Name
Mailing Address:
City: State: Zip Code: County:
Day Tele No,: CeII No.:
EMAIL Address: Fax No.:
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Matthew James, P.G.
Company Name WithersRavenel. Inc.
Mailing Address: 115 MacKenan Drive
City: Cary State: NC Zip Code: 27511 County: WAKE
Day Tele No.: 919-469-3340 CeII No.: 919-669-8045
EMAIL Address: [e-mail] withersravenel.com Fax No.: 919-467-6008
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address: NCDOA - Albemarle Building
325 North Salisbury Street
City: Raleigh County: Wake Zip Code: 27603
(2) Geographic Coordinates: Latitude**: 35° 47' 4.14"
Longitude": 78° 38' 26.93"
Reference Datum: Accuracy:
Method of Collection: Google Earth
**FOR AIR INJECTION AND AQUIFER TEST WELLS ONLY: A FACILITY SITE MAP WITI1 PROPERTY
G. TREATMENT AREA
Land surface area of contaminant plume: 2,355 (Est) square feet
Land surface area of inj. well network: =980 square feet (< 10,000 IV for small-scale injections)
Percent of contaminant plume area to be treated: =42% (must be C 5% of plume for pilot test infections)
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.
[)reined Permitted GW Remcdiutinn NOI Rev. 6/1/2017 Page 2

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.
Purpose: E limination of free-pha se petroleum product on groundwater s urface at location.
Scope: Injection of En iroC lean surfactant into ex is ting mo nitoring wells. MW-I and MW-6 follov ed by the
performance of a s urfactant enhanced reL:over v event (8-hour AFVR event) through monitoring we ll s MW-I
and MW-6.
Goals: Reduction of source area contamination through remova l of Fre e-phase c ontamination with Lhe 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 online at http://deg .nc .gov /about/divisions/water-
resources \ ater-re s ource -permit ·:waste, ater-branchiground-water-protection, ground-water-appro ed-injectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UIC Program for more info
(919-807-6496).
lnjectant: EnviroClean Surfactant
Volume of injectant: ro Gallons (5 gallons EnviroClean di.luted with water to .. % s olution)
Concentration at point of injection: 2% Mixture with potable water
Percent ifin a mixture with other injectants: ---=2~o/c'-"o-=E=n~v~i~ro~C~l=e=an=·'--'9""8'-'o/c'-"o'""p'""o=ta=b"""l-=-e--'-w-'--'a=t=er'-------
lnjectant: ----------------------------------
Volume of injectant: _____________________________ _
Concentration at point of injection: ________________________ _
Percent if in a mixture with other injectants: ____________________ _
K. WELL CONSTRUCTION DATA
(I) Number of injection wells: ---=-0 ___ Proposed. __ --=2'--__ Existing (provide G W-Is)
(2) For Proposed wells or Existing wells not having G W-1 s, 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: Ouantex NC Certification #:_~3~1-=-06=A---=---
Deemed Permitted GW Remediation NOi Rev. 6/1/2017 Page 3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
Following approval. schedule includes:
1. Gauging of site monitoring. wells .(Day 1).
2. Injection of surfactant into wells (Day 1)
3. Performance of a post -injection free phase product recovery event (Day 5)
4. Performance afa site -wide groundwater gauging and monitoring event (Week 4)
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 from the injection activity.
After completion of injection and post -infection 8-hour AFVR event at the facility, WR will complete a
groundwater sampling event at the site after one month time following the AFVR event to determine whether
the injection of material has had the desired effect (ex... depletion of free phase petroleum product at the site).
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby cert y, 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 it formation 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 l z_A .VC -IC 02C 0200 Rules."
Signature of Applicant
G. Matthew James. PG. on behalf of NC- Dept. of Administration
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, 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 {lam 4t .1't. AC 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.
_Ito, L i1 V' Z4 lei-LEI-to,i 2/rCc/A - J C_1
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 farm.
Submit the completed notification package to:
DWR— UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation N01 Rev. 6/1/2017 Page 4

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LEGEND
▪ TYPE II MONITORING WELL LOCATION
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IMPLIED EXTENT OF FREE PRODUCT
(DASHED WHERE INFERRED)
NOTES:
1. 2013 AERIAL OBTAINED FROM THE WANE COUNTY GIS DEPARTMENT.
2. "NM" DENOTES "NO FREE PRODUCT MEASURED".
TRANSFORMER
GENERATOR
ESTIMATED EXTENTS OF
I _ FREE PHASE PRODUCT
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NOTES
1. GRAYED WELL LOCATIONS FOR REFERENCE ONLY. THESE WELLS OBSCURED IN
TWO DIMENSIONAL PRESENTATION.
2. VISUAL ABERRATION OF STRUCTURAL COMPONENTS DUE TO DIFFERENCES IN
HORIZONTAL AND VERTICAL SCALES.
3. NAPHTHALENE CONCENTRATIONS SHOWN IN THE FOLLOWING FORMAT "(VALUE)"
4. • NAPHTHALENE CONCENTRATION SHOWN FOR MW-1 FROM SEPTEMBER 22, 2010
SAMPLING EVENT.
5. CONTAMINANT EXTENTS DASHED WHERE INFERRED.
LEGEND
TYPE II MONITORING WELL LOCATION
IPROPOSED INJECTION POINT
ESTIMATED EXTENT OF GROUNDWATER
NAPHTHALENE IMPACT EXCEEDING 2L STANDARD
ESTIMATED EXTENT OF FREE PRODUCT
STORM WATER LINE
—" — WATER LINE
-- — — BURIED ELECTRICAL CONDUIT/DUCT BANK
BURIED STEAM LINE
0 MANHOLE
DROP INLET
FIRE HYDRANT
NOTES:
1. 2013 AERIAL PHOTOGRAPH AND UTILITY LOCATIONS OBTAINED FROM
THE WAI(E COUNTY GIS DEPARTMENT.
• GRAPHICSCALE
15 30
linch =30 ft.
ESTIMATED UST LOCATION
(CLOSED I N-PLACEI
ESTIMATED EXTENT OF FREE
PRODUCT (07/20/16)
85.00
GENERA
b.
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HORIZONTAL SCALE
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NOTES
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WELLS OBSCURED IN TWO DIMENSIONAL PRESENTATION,
2 VISUAL ABERRATION OF STRUCTURAL COMPONENTS DUE
TO DIFFERENCES IN HORIZONTAL AND VERTICAL SCALES-
3. NAPHTHALENE CONCENTRATIONS SHOWN IN THE
FOLLOWING FORMAT' {VALUE)"
4 ' NAPHTHALENE CONCENTRATION SHOWN FOR MW-1 FROM
SEPTEMBER 22, 2010 SAMPLING EVENT.
5 CONTAMINANT EXTENTS DASHED WHERE INFERRED.
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ESTIMATED EXTENT OF GROUNDWATER
NAPHTHALENE CONTAMINATION
EXCEEDING 2L STANDARD (JUNE 17, 2016)
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LEGEND
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• TYPE II MONITORING WELL LOCATION
(. ] PROPOSED INJECTION POINTS
(93.31) GROUNDWATER ELEVATION (FEET)
— 91 —IMPLIED GROUNDWATER ELEVATION
IMPLIED GROUNDWATER FLOW
NOTES:
1. GROUNDWATER SURFACE ELEVATIONS ARE BASED ON A
1 DO -FOOT BENCHMARK ESTABLISHED AT THE TOP OF
CASING FOR I CI1lTOR1NG WELL MW-2.
2. GROUNDWATER ELEVATION DATA SHOWN HEREON BASED ON
FIELD MEASUREMENTS OBTAINED ON JUNE 17. 2016.
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N RESIDENT I4 w r.l, r ONSTr>zU I•IO,N REC Oitn
North crirs•titr:r 1)opartmetit 01 t•atti ironment end 1.t11uritl Irtoso lri-e - Iii,isiniI i,f V. tiler i hr:ri1t}
1i'F'L1. CONTRACTOR C1sRTI t IC::t'I it7N #
1. WELL CONTRACTOR:
Stephen W. Keener
Well Contractor (Individual) Name
Quantex, Inc.
Contractor Company Name
P.O Box 41673
#re t F�d'lress
weigh NC 27629
City OF 'Town Stale Zip Code
(919 1 219-9604
Area rode Phone slumber
2. WELL iNFORMATION.
WELL i3ONSTRUCTION PERMIT#
OTHER ASSOCIATED PEW/VT/Rif appi,nbte) NA
SITE WELL :D #prapprrraUlr.; ` T- �L
3 WELL USE (Check One Box) Monitonng'r MunicipapYrst;lit:
inotisrtiakCommeroral ; : Aygrlcullurai ; Recovery 11 Infection
Irrsgafion'. ; Carter , (list use)
DATE DRILLED 9l22I1 G
is. WELL LOCATION:
412 North McDowell Street, 27603
5r:ea! hrlrne N. n,uc + Ccunm .s l�v $i i- is�n tnt rin Pa•cri. zpr, waeey
crTY Raleigh COUNTY Wake
TOLOGRAPHI'C !LAND SF TONG: ;r. =e appropriate iireglope Valley !:_Flat •'Ridge ; Other
LATITULJE 3e �' DMS :35 785036 Dp
1"0'Nt !rLPD: 'S •
' DMS 7f 642020 o
Latitude/longitude source: itiPS i ,Topographic map
(location of well must be shown on a USGS ropo trap andatfactico to
rt s form if not using GPSj
. FACfLITY {Name of the business where the well is located i
Albemarle Building
•
412 North McDowell Street
Facility ID# tit applicable)
;street P•.cturess
Raleigh NC 27603 . '` 1
3468-4
' d. TOP OF CASING is (•0•20) FT Above Land Surface'
'Top of casing terminated at/or below land surface may require
a variance in accordance with SSA NCI+C 2C 0116.
a. YIELD Wpm) NA _-- -- METHOD OF TEST NA__
t. DISINFECTION: Type NA Amount NA
9, WATER ZONES rdeplhi _
Top Bottom : Trap_ 3nttnrs
Top Bottom _ Top Bottom_
Too Bottom_ T6p Bollorn"
Thickness/
7. CASING: Depth ❑iameier Weight Material
Top CI; Bottom" 3 T r 2" sch40 PVC
Top - Bottom Ft"
Top Bottom� — Ft
8. GROUT: Depth Mate/iar Method
Top_ r Bottom i Ft.. Neat Cement Pour
Tap_ a L otroral _ f-t. BenIonite Pour
Top Bottoui__� FI
9. SCREEN: Depth Diameter Slot Sire Material
Top--3 Boitcni t 3 _ Fi 2"' in 0,010,0 PVC
Top Bottom _ Ft. _In in, -
To --_-- eottrnt "-- rt __ _ to In
10. SANOIGRAVEL PACK:
7 Depth Size Material
Top. L Bot.om_1 ' ri #r Silica Sand
op_ --Bottom__ Ft _
Top Bottom Ft.
11. DRILLING LOG
Top E3ottsr=i
r
1
C,ty or Town Sias:, rci Code
Mr. Fady Wahby (State Construction Office)
Contact Name
1307 Mail Service Center
Marling .Address
Raleigh NC 27699
t:I Of Town 61aut Zip Code
NA
:krrm code none number
6. WELL :DETAILS:
a. TOTAL DEPT}t' 131
U. DOES WELL REPLACE EXISTING WELL? 'ITS _. fd : 1/
WATER LEVEL below Top y; Cas,rlg• NA
C150 { ,t Above ..op of Casino)
12. REMARKS":
•;armation Oescr:pcon
r
I , _
• SIGNATURE I IEDIWELLCONTRACTOR ['Alf-.
- Stephen \N Keener
PP.JN T ED r•iRMF IS(1N CONSTRUCTING THE WEI t
;1T.1
Stsbrnit within 30 days of comptetion to: (Division of Water Quality - Information Processing,
1617 Maif Srrvice Center Rareiah. NC 27699-161. Phone : f9191 807-6300
io ...•TU

WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
li!!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/15/16 M W -2
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 84509 78.6 4 0663
N w
6. Is (are) th e well(s). liiilPermanent or □ femporary
7. Is this a repair to an existing well: □Yes or l!No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : ___________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : _________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 40 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 8 ft. G rayish Brown SILT
8 ft. 10 ft. Gray Sandy S il LT
10 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty L.::..::-=====~:=-========-_..:.:=:==-=========:J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
i!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/15/16 M W-3
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 84589 78.6 4071 4
N w
6. Is (are) th e well(s). li!!Permanent or □ femporary
7. Is this a repair to an existing well: □Yes or ~No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : ___________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : _________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 40 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 7 ft. G rayish Brown SILT
7 ft. 10 ft. Gray Sandy S il LT
10 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty L.::..::-=====~:=-========-_..:.:=:==-=========:J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
i!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/15/16 M W -4
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 847 16 78.6 40717
N w
6. Is (are) th e well(s). lii!!Permanent or □ femporary
7. Is this a repair to an existing well: □Yes or ~No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : ___________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : _________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 40 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 8 ft. G rayish Brown SILT
8 ft. 10 ft. Gray Sandy S il LT
10 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty L.::..::-=====~:=-========-_..:.:=:==-=========:J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
i!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/16/16 M W-5
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 84505 78.6 40870
N w
6. Is (are) th e well(s). lii!IPermanent or □ femporary
7. Is this a repair to an existing well: □Yes or ~No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : __________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : ________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 4 0 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 6.5 ft. G rayish Brown SILT
6 .5 ft. 11 ft. Gray Sandy S il LT
11 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty t..:::..::.:..=:===:....:~::....:=======--=-===-=========...J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
i!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/16/16 M W-6
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 845 9 3 78.6 40863
N w
6. Is (are) th e well(s). liii!Permanent or □ femporary
7. Is this a repair to an existing well: □Yes or ~No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : ___________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : _________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 4 0 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 6 ft. G rayish Brown SILT
6 ft. 11 ft. Gray Sandy S il LT
11 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty L.::..::-=====~:=-========-_..:.:=:==-=========:J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
WELL C ONSTRUCTION RECORD
This form can be used for single or mult iple wells
1. Well Contractor Information:
James D. Barker
Well Contractor Name
3106A
NC Well Contractor Certification Number
Quantex, In c .
Company Name
2. Well Construction Permit #:
List all applicable well construction permits (i.e. Coumy, S tate, Variance, etc.)
3. Well Use (check w ell use):
Water Supply Well:
□Agricultural □Municipal/Public
□Geothermal (Heating/Cooling Supply) □Residential Water Supply (single)
□Industrial/Commercial □Residential Water Supply (s hared)
□Irrigation
Non-Wa ter Supply Well:
i!Mon itoring □Recovery
Injection Well:
□Aquifer Recharge □Groundwater R em ediation
□Aquifer Storage and Recovery □Sa linity B arrier
□Aquifer Test □Stormwater Drainage
□Exp erimental T echnology □Subsidence C ontrol
□Geothermal (Closed Loo p) □Tracer
□Geothermal (Heating/Cooling Return) □Other (explain un der #21 Remark s)
6/16/16 M W-7
4. Date WeU(s) Completed: WeUID#
Sa. Well Location:
NC DOA A lbemarle Bldg . NA
Fac ility/Owner Name Facility JD# (if applicable)
325 N . Salisbury St reet, Raleigh, NC 27603
PWak~ddress, City, and Zip NA
County Parcel Identification No. (PIN)
Sb. Latitude and Longitude in degrees/minutes/seconds or decimal degrees:
(if well field, one lat/long is sufficient)
35.7 84597 78.6 4 10 57
N w
6. Is (are) th e well(s). liii!Permanent or □ femporary
7. Is this a repair to an existing well: □Yes or ~No
If this is a repair,fl/1 out known well c onstruction information and explain the nature of the
repair under #21 remark, section or on the back of this form.
o ne
8. Number of wells constructed : __________ _
For multiple injection or non-water supply we/is ON LY with rhe same construction, you can
submit one form. 13'
9. Tota l well depth below land surface: _____________ (ft.)
For multiple wells list all depths if different (example-3@200' and 2@100")
NA
10. Static wa ter level below top of casing: ____________ (ft.)
If water level is above casing, use "+"
~7"
11. Borehole diameter: ---~---(in.)
A ug er
12. Well construction method : ________________ _
(i.e. auger, rotary, cable, direct push, etc.)
FOR WATER SUPPLY WELLS ONLY:
13a. Yield (gpm) ________ Method of test: _______ _
I For Internal Use ONLY:
14. WATERZO~ES
FROM T O DESCRIPTION
4 ft. 5 ft. G rayish Brown S ilt
ft. ft.
15. OUTER CASING (for multi-cased wells) OR LINER (if aoolicablel
FROM TO DIAMETER I TffiCKNESS I MATERIAL
0 ft. 3 ft. 2 in. Sch 40 PVC
16. INNER CAS ING OR TUBING (eeothermal closed-loop)
FROM T O DIAMETER TffiCKNESS MATERl,\L
ft. ft. in.
ft. ft. in.
17.SCREEN
FROM TO DIAMETER SL OT S IZE TmCKNESS MATERIAL
3 ft. 13 ft. 2 in. 0 .010 Sch 40 PVC
ft. ft. in.
18.GROUT
FROM T O MATERIAL EMPLACEME.'<T METHOD & AMOU"IT
0 ft. 2 ft. neat cement Pour -60 lbs. neat cement
2 ft. 2 .5 fl. bentonite Pour -20 lbs. 3/8 " bentonite
ft. ft.
19. SAi~D/GRA VEL PACK (if aoolicable)
FROM T O MATERIAL EMPLACEMENT METHOD
2 .5 ft. 13 ft. #2 sand Pour
ft. ft.
20. DRILLING LOG (attach additional sheets if necessary)
FROM TO DESCRIPTION (color ha rdness soil/rock h1>e [!rain size etc.)
0 ft. 1 ft. Gravel
1 ft. 7.5 ft. G rayish Brown SILT
7 .5 ft. 10 ft. Gray Sandy S il LT
10 ft. 13 ft. Gray Silt/Part iall y Weathe red Rock
ft. ft.
ft. ft.
ft. ft.
21 . REMARKS
22. Certif'f on :
~/ 6L ~ 6/28/16
'--
Si gnature ofj ertified Well Contractor Date
By s igning this form, I hereby certify that the well(s) was (were) constructed in accordance
with J 5A NCAC 02C .0100 or J 5A NCAC 02C. 0200 Well Construction Standards and that a
copy of this record has been provided to the well owner.
23. Site diagram or additional well details:
You may u se the back of this page to p rovide a dditional well s ite d etails or w ell
c onstruction details. You may also attach additional pages if necessary.
SUBMITTAL INSTUCT IONS
24a. For All Wells: Submit this form within 30 days of c ompletion of well
construction to the follow ing:
Division of Water Quality, Informa tion Processing Unit,
1617 Mail Service Center, Raleigh, NC 27699-1617
24b. For Injection Wells: In add itio n to sending the form t o the ad dress in 24a
above, a lso submit a copy of this form within 30 days o f completion o f w ell
construction to the followi ng:
Division of Water Quality, Underground injection Control P ro gram,
1636 Mail Service Center, Raleigh, NC 27699-1636
24c. For Water Supply & Injectio n Wells: In addition to sending the form to
the address(es) ab ove, a lso submit on e copy of this form within 30 d ays of
13b. Disinfection type: Amount: completion of well construction to the county health department of the c ounty t..:::..::.:..=:===:....:~::....:=======--=-===-=========...J wh ere c onstructed .
Form GW-1 North Carolina Department of Environment and Natura l Resources-Division of Water Quality Revised Jan. 2013
S A F E T Y D A T A S H E E T

SECTION 1 MATERIAL IDENTIFICATION

PRODUCT NAME / DESCRIPTION: EnviroClean

DISTRIBUTED / MANUFACTURED BY:
ENVIRO CLEAN PRODUCTS & SERVICES DATE: 05/18/2015
PO BOX 721090 PHONE: [phone]
OKLAHOMA CITY, OK 73172 EMERGENCY PHONE: [phone]

FUNCTION: Industrial Cleaner and Remediation Agent

SECTION 2 HAZARD IDENTIFICATION

CLASSIFICATION:
Acute Toxicity- Oral Category 4
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
ENVIR LEAN
Store in a well ventilated place

TOXICITY INFO:
See Section 11.

SECTION 3 HEALTH HAZARDS

CHEMICAL NAME %W/W 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: May cause irritation with redness and pain.
Skin: May cause irritation with redness and pain.
Inhalation: Inhalation may cause irritation.
Ingestion: Ingestion may cause severe irritation, corrosion/ulceration, nausea, and vomiting.

Medical Conditions Aggravated by Exposure:
None known.

Eye Contact: 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.
Skin Contact: Wash with soap and water. Get medical attention if irritation occurs. Wash
clothing before reuse. Destroy contaminated shoes.
Inhalation: 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.
Ingestion: 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.

SECTION 5 FIRE FIGHTING MEASURES

Fire Hazard Classification (OSHA/NFPA): 0
Extinguishing Media: As required for fire being fought.
Special Fire Fighting Procedures: Use self-contained breathing apparatus.
Hazardous combustion products: No known.

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: 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.
Storage: 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 NIOSH/MSHA 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
Odor: Wintergreen
Odor Threshold: NE
pH: 8.5+/-0.5
Boiling Point: NE
Melting Point: N/A
Flash Point: >200 deg F
Evaporation Rate (Butylacetate = 1) NE
Flammability: Non-Flammable
UEL: NE
LEL: NE
Vapor Pressure: NE
Vapor Density: NE
Specific Gravity (Water = 1): 1.03 +/- .05
Solubility Water: Complete
Partition Coefficient: NE
Auto-ignition Temperature: NE
Decomposition Temperature: NE
Viscosity (CPS): NE

SECTION 10 STABILITY AND REACTIVITY

Stability: This product is stable under normal temperatures and pressures.
Incompatibility: Strong Oxidizers and strong acids.
Decomposition Products: No Known hazardous products.
Conditions to Avoid: Sparks/flames/high heat.

SECTION 11 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

BIOACCUMULATION:
NE

MOBILITY
NE

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 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

NFPA HAZARD INFORMATION SIGN

[0] HEALTH HAZARD (BLUE DIAMOND) [0] REACTIVITY HAZARD (YELLOW DIAMOND)
4 – DEADLY 4 – MAY DETONATE
3 – EXTREME DANGER 3 – SHOCK AND HEAT MAY DETONATE
2 – HAZARDOUS 2 – VIOLENT CHEMICAL CHANGE
1 – SLIGHTLY HAZARDOUS 1 – UNSTABLE IF HEATED
0 – NORMAL MATERIAL 0 – STABLE

[0] FIRE HAZARD (RED DIAMOND) [] SPECIFIC HAZARD (WHITE DIAMOND)
FLASH POINTS: OXY OXIDIZER
4 – BELOW 73 F ACID ACID
3 – BELOW 100 F ALK ALKALI
2 – BELOW 200 F COR CORROSIVE
1 – ABOVE 200 F W USE NO WATER
0 – WILL NOT BURN

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.

ENVIR LEAN
EnviroClean
Degassing/Hydrocarbon Removal/Remediation Chemistry

Page 1 of 2
PHYSICAL PROPERTIES

Product Name EnviroClean

Physical Form Clear Liquid

Color Colorless unless dyed

Specific Gravity (Water = 1) 1.028 +/- .01

Solubility in Water 100%

Freezing/Melting Point NE

Flash Point (0F) >2000 F

pH 8.5 +/- .25

Reportable Quantity (RQ) 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 VOCs,
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.

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
EnviroClean, 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
Page 2 of 2
hydrocarbons into a very good nutrient source for
bacteria and microbes.

EnviroClean is typically 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 temperature
of the application 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
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.