WI0400514_DEEMED FILES_20190201

Permit Number
Program Category
Deemed Ground Water
Permit Type
WI0400514
Injection Deemed In-situ Groundwater Remediation Well
Primary Reviewer
shristi.shrestha
Coastal SWRule
Permitted Flow
Facility
Facility Name
Sam's Mart# 97(Former Crown NC-015)
Location Address
1102 Summit Ave
Greensboro
Owner
Owner Name
Sam's Mart LLC
Dates/Events
Orig Issue
2/1/2019
NC
App Received
1/17/2019
Regulated Activities
Groundwater remediation
Outfall
Waterbody Name
27405
Draft Initiated
Scheduled
Issuance Public Notice
Central Files: APS SWP
2/1/2019
Permit Tracking Slip
Status
Active
Version
1.00
Project Type
New Project
Permit Classification
Individual
Permit Contact Affiliation
Major/Minor
Minor
Region
Winston-Salem
County
Guilford
Facility Contact Affiliation
Owner Type
Non-Government
Owner Affiliation
Adnan Jazairi
President Vice
7935 Council Pl
Matthews
Issue
2/1/2019
Effective
2/1/2019
NC 28105500
Expiration
Requested /Received Events
Streamlndex Number Current Class Subbasin
DATE: , 20
North Carolina Department of Environmental Quality — Division of Water Resources
NOTIFICATION OF INTENT (NOE) 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 159 NCAC 02C.0200. This form shall be submitted al 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.
fNSITUREMEDIATION t 15A NCAC 02C .02251 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.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As !ncomplele.
PERMIT NO. W U O [)51 Ili (to be filled in by DWR)
A. WELL TYPE TO BE CONSTRUCTED OR OPERATED
(i) 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 S through F, H-N
(4) X Small -Scale injection Operation Complete sections 13 through N
(5) Pilot Test Complete sections B through N
(6) Tracer Injection Well Complete sectiorRi egiw N
� Cps, �n
B. STATUS OF WELL OWNER: Business/Organization ,/AN
C. WELL OWNER(S) — State narne of Business/Agency. and Name and Title oPpygAtIELI494md authority to
sign on behalf of the business or agency: °@ration,,
Name(s): Sam's Mart. Inc.
Mailing Address: 7935 Council Place. Suite 200
Adrian Jazairi. COO
City: Matthews State: NC Zip Code:28105 County: Mecklenburn
Day Tele No.:
704 567-8424 Cell No.:
EMAIL Address: Fax No.:
Deemed Permitted GW Remediation NO] Rev. 8-28-2017 Page 1

D. PROPERTY OWNER(S) (if different than well owner)
Name and Title: ------'S=am=e:..=as"-'-'w-=e=-=ll -==o'-'-w-'..::n.,_,e"'-r ______________________ _
Company Name ---------------------------------
Mailing Address:---------------------------------
City: _____________ State: __ Zip Code: _______ County: _____ _
Day Tele No.: ____________ _ Cell No.: __________ _
EMAIL Address: _____________ _ Fax No.: ___________ _
E. PROJECT CONTACT (Typically Environmental Engineering Firm)
Name and Title: Mike Stanforth. Princi pal Engineer
Company Name ---=E=x~ce=l~C=i~v=il ~&~E=n~v=ir~o=nm=e=nt=a~l =A=s~so=c=ia=t=e=-s _______________ _
Mailing Address: ___ 6_2_5~H~u=n=ts=m=an=·~C~o~u~rt ______________________ _
City: Gastonia State: NC Zip Code: 28054 County:~G~a=st~o=n _____ _
Day Tele No.: 704 853-0800 Cell No.: __________ _
EMAIL Address: mstanforth@excelengr .com Fax No.: 704 853-3949
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name & Address : Sam's Mart No. 97 / (Former) Crown NC-015
1102 Summit A venue
City: ___ G~r~e~en~s~b~o~ro~ ____ County: Guilford 2..J-4-0S Zip Code:.~~~~---
(2) Geographic Coordinates: Latitude**: _0 ____ " or J.Q___0 .~0~89~4=0~5 _____ _
Longitude**: 0 "or ]!i..__0 .-'--7-"-'73,,_,3=8"-'7 _____ _
Reference Datum:. ________ Accuracy: ________ _
Method of Collection:----'G=-o=o'"-g=le~E=arth~=20=1~9~----------
**FOR AIR INJECTION AND AQUIFER TEST WE LLS 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: __ ~_7~0~0 ____ square feet
Land surface area of inj. well network: ~800 square feet (~ 10 ,000 ft 2 for small-scale injections)
Percent of contaminant plume area to be treated: 100% (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 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.
The injection will be com pleted usin g tem porary wells using the push -in ject -pull method. The bore holes
will be filled in using bentonite hole plu g u pon com pletion. The injection of a total volume of 998.2 gallons
will be distributed evenly between three locations at total de pths of25 feet. The injection process will take two
to three days to com plete. See Section J below and attached SDS sheets for details on the injectants . and see
the attached fi gures for in jection locations. The goal of the in jections is to remediate the presence of EDB
around MW-1 lR.
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 htrp ://deg .nc.gov/about/divisions/water-
resources/water-resources-pennits/wastewater-branch/gr ound-water-protection/gro und-water-a pproved-in jectants.
All other substances must be reviewed by the DHHS prior to use. Contact the UJC Program for more info
(919-807-6496).
Injectant: ___ K_l_o=z=ur~S=P~--------------------------
Volume of injectant: __ 7~2~3~.2_g~al_Io~n~s ______________________ _
Concentration at point of injection: ___ 2_0_o/c~o ___________________ _
Percent if in a mixture with other injectants: __ __,_7=2=.5'--'-o/c--=-o _______________ _
lnjectant: ___ S~o~d~iu~m~H_y_d~r~o_x1~·d=e~<N~a~O~H~) ________________ _
Volume of injectant: -~2~7~5-g.,.._a~ll~o~n~s ______________________ _
Concentration at point of injection: __ _,2=5'--'-o/c--=-o ___________________ _
Percent if in a mixture with other injectants: ---=2'-'-7=.5'----0-'--'1/oc.___ ______________ _
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: ---=-3 ___ Proposed'-------=0 ___ Existing (provide GW-ls)
(2) For Proposed wells or Existing wells not having GW-ls, provide well construction details for each
injection well in a diagram or table format. A single diagram or line in a table can be used for
multiple wells with the same construction details. Well construction details shall include the
following (indicate if construction is proposed or as-built):
(a) Well type as permanent, Geoprobe/DPT, or subsurface distribution infiltration gallery
(b) Depth below land surface of casing, each grout type and depth, screen, and sand pack
(c) Well contractor name and certification number
Deemed Permitted GW Remediation NOI Rev. 8-28-2017 Page3
L. SCHEDULES — Briefly describe the schedule for well construction and injection activities.
The injections and temporal-4 borinu abandonments will occur over aj eriodof two to three dal, s.
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 02.L. result from the injection activity.
A subsequent groundwater sampling event will occur approximatel\ 45 days after injections.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
APPLICANT: "I hereby certify, under penalty of law, that I am familiar with the information submitted in
this document and all attachments thereto and that, based an my inquiry of those individuals immediately
responsible for obtaining said information, I believe that the information is true, accurate and complete. I am
aware that there are significant penalties, including the possibility of fines and imprisonment, for 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 15.4 NCAC 02C 0200 Rules. "
Signs ;j`�'of Applicant
Fe1— 5A":4 r>!► AI/0W 5r i 7I
Print or Type Full Name and Title
PROPERTY OWNER if the properly is not owned b% the permit applicantl:
"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' (' 3A _NC='./ C (2( 0 0 ),
"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 form.
Please send this NOI electronically to Shristi.Shresthau ncdenr.vov AND one bard copy to:
DWR — UIC Program
1636 Mail Service Center
Raleigh, NC 27699-1636
Telephone: [phone]
Deemed Permitred GW Remediation NOI Rev. 8-28-2017 Page 4

EXCEL CIVIL & ENVIRONMENTAL
ASSOCIATES, PLLC
302 S. CHURCH STREET, SUITE B
GASTONIA, NC 28054
(704) 853-08000
FIGURE 1 -
SITE VICINITY MAP
Source: U S.G.S. 7.5 Minute Topographic Map
Greensboro, NC, Quadrangle, 1994
N

q.
po"
U
LEGEND
— Property Line (Approximate)
Former UST System (Approx)
Type II Well Location
Type lii Well Location
Abandoned Welt
r•
•r
r�.1
TREATMENT
SYSTEM
NOTES
Mop adopted from Site Pion by Clare
doted 12/23/O2.
UST — Underground Storage Tank
Excel
Civil eft En vffonmentalAssocrates, PLLC
me sour?? ENVICN ST. G.4aro N.MP PWOW.: (V@MN.
PREPARED FOR.: CROWN CENTRAL PETROLEUM, CORPORATION
FORMER CROWN PIC-015
I102 SUMMIT AVENUE, CREENSBORES NC
MA P TITLE ;
FIGURES -SITE PLAN
NOTICE' OF warn -
PROJECT NO.:
24046
PRAWN BY:
COD
SCALE
1"
DATE:
1111R019

L�
O
1 U51 BP�'N
G5 \
s\Ao'
` OS-3
MAY —in
LEGEND NOTES
Property Line (Approximate) Map adapted from Site Pion by Qore
Former UST System (Approx) doted 12/23/02.
Type II Well Location Data from samples collected on 1/78/18
Type III Well Location Data provided in ug/I
@.) Abandoned Well EDO — Ethylene Dibromide
Constituent Level
•r
EDE
MW-5
Approximate extent of contaminant
_
•1 .1� dst BA MW- 25
S) '401 bAW 3
IIAW—B
•
+.rW-18
ti
Excel
Ci vi7& Environmental Associates, PLLC
12 SOUTH CYM1IC1(ST. G.fNSaMi, Hf.' PRONE g erm1 f111VRi
PREPARED FOR: CROWN CFFTRILPETROLEUM CORPORATION
FORMER CROWN NNCC 015
1IOZ SUMMITAv+ENUI% GREENSBORO, NC
MAP TITLE :
FIGURE 3 -GROUNDWATER CONS7I7UENTS MAP
NOTICE OF INTENT
PROJECT NO. :
24846
DRAWN BY
CBU
SCALE :
DA1'1L
11! 112019

A
f
O
Sc,"
•
•
LEGEND
— Property Line (Approximate)
Former UST System (Approx)
Type II Well Location
Type III Well Location
Q Abandoned Well
• Proposed Injection Location
TREATMENT
SYSTEM
NOTES
Map adopted from Site Plan by Gore
dated 12/23/02.
UST — Underground Storage Tank
Excel
Cirril & Environmental Associates, PLLC
!p 906711 CALEO!S . GASTOM.c Nc rNwea, rmUas-OWN,
PREPARED FOR: CROWN CENTRAL PETROLEUM.CORPORAT►ON
FORMER CROWNNE-015
HOT SUMMIT AVENUE, GREENSBORO, NC
MAP TITLE : FIGURE 4 - PROPOSED INJECTION LOCATIONS
NOTICE OF INTE'N7
PRWCCT No. DRAWN BY : SCALE BA1'E
74046 COO 1"+30' If1111619

SAFETY DATA SHEET
Klozur® SP
SOS # : 7775-27-1-12
Revision date: 2018-07-13
Format: NA
Version 1.04
PeroxyChem
1. PRODUCT AND COMPANY IDENTIFICATION
Product Identifier
Product Name
CAS -No
Synonyms
Klozur® SP
7775-27-1
Sodium Persulfate; Sodium Peroxydisulfate, Disodium Percxydisulfate; Peroxydisulfuric
acid, disodium salt; Peroxydisulfuric acid, sodium salt.
Alternate Commercial Name Klozur® Persulfate
Recommended use of the chemical and restrictions on use
Recommended Use: In situ and ex situ chemical oxidation of contaminants and compounds of concern for
environmental remediation applications
Restrictions on Use No uses to be advised against were identified.
Manufacturer/Supplier
Emergency telephone numbers
PeroxyChem LLC
2005 Market Street
Suite 3200
Philadelphia, PA 19103
Phone: [phone] (General Information)
E-Mail: [e-mail]
For leak, fire, spill or accident emergencies, call:
1 800 / 424 9300 (CHEMTREC - U.S.A.)
1 7031527 3897 (CHEMTREC - Collect - All Other Countries)
1 303/ 389-1409 (Medical - U.S. - Call Collect)
L
2. HAZARDS IDENTIFICATION
Classification
OSHA Regulatory Status
This material is considered hazardous by the OSHA Hazard Communication Standard (29 CFR 1910,1200)
.Acute toxicity - Oral
Category 4
Skin corrosion/irritation
Category 2
Serious eye damage/eye irritation
Category 28
Respiratory sensitization
Category 1
Skin sensitization
Category 1
Specific target organ toxicity rsingle exposure)
Category 3
Oxidizing Solids
Category 3
Page 1 19

Klozur® SP
SDS # : 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
GHS Label elements, including nrecautiona y statements
EMERGENCY OVERVIEW
Danger
Hazard Statements
H334 - May cause allergy or asthma symptoms or breathing difficulties if inhaled
H335 - May cause respiratory irritation
H320 - Causes eye Irritation
H315 • Causes skin irritation
H317 - May cause an allergic skin reaction
H302 - Harmful if swallowed
H272 - May intensify fire: oxidizer
Precautionary Statements - Prevention
P261 - Avoid breathing dust.
P285 - In case of inadequate ventilation wear respiratory protection
P271 - Use only outdoors or in a well -ventilated area
P280 - Wear.protective gloves/ protective clothing
P264 - Wash face, hands and any exposed skin thoroughly after handling
P210 - Keep away from heat/sparks/open flames/hot surfaces. - No smoking
P220 - Keep/Store away from clothing/combustible materials
P221 - Take any precaution to avoid mixing with combustibles
Precautionary Statements - Response
P305 + P351 + P338 - IF IN EYES: Rinse cautiously with water for several minutes. Remove contact lenses, if present and easy to
do. Continue rinsing
P337 + P313 - If eye irritation persists: Get medical advice/ attention
P302 + P352 - IF ON SKIN: Wash with plenty of water.
P333 + P313 - If skin irritation or rash occurs: Get medical advice/ attention
P304 + P341 - IF INHALED: If breathing is difficult, remove to fresh air and keep at rest in a position comfortable for breathing
P342 + P311 - If experiencing respiratory symptoms: Call a POISON CENTER or doctor
P301 + P312 - IF SWALLOWED Call a POISON CENTER or doctor if you feel unwell
P330 - Rinse mouth
P370 + P378 - In case of fire: Use water spray for extinction
Precautionary Statements - Storage
P403 + P233 - Store in a well -ventilated place. Keep container tightly closed
Hazards not otherwise classified IHNOC)
No hazards not otherwise classified were identified.
Other Information
Risk of decomposition by heat or by contact with incompatible materials
Unknown acute toxicity
0% of the mixture consists of ingredient{sl of unknown toxicity
Page 219

Klozur® SP
SDS #: 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
3. COMPOSITION/INFORMATION ON INGREDIENTS I
Formula
General Advice
Eye Contact
Skin Contact
Inhalation
Ingestion
Chemical name
Sodium Persulfate
Sodium sulfate
Most important symptoms and
effects, both acute and delayed
Indication of immediate medical
attention and special treatment
needed, if necessary
Suitable Extinguishing Media
Unsuitable extinguishing media
Specific Hazards Arising from the
Chemical
Flammable properties
Explosion data
Sensitivity to Mechanical Impact
Sensitivity to Static Discharge
Protective equipment and
precautions for firefighters
Personal Precautions
Other
Environmental Precautions
Na2O8S2
CAS-No Wei Qht%
7775-27-1 > 99
7757-82-6 <2
4. FIRST AID MEASURES
May produce an allergic reaction.
Rinse thoroughly with plenty of water for at least 15 minutes, lifting lower and upper eyelids
intermittently. Consult a physician. If symptoms persist, call a physician.
Wash off immediately with soap and plenty of water while removing all contaminated
clothes and shoes. Get medical attention if irritation develops and persists.
Remove from exposure, lie down. If breathing is irregular or stopped, administer artificial
respiration. Call a physician immediately.
Do NOT induce vomiting. Call a physician or poison control center immediately. Rinse
mouth. Drink 1 or 2 glasses of water.
Itching; Redness; Coughing and/ or wheezing.
Treat symptomatically
5. FIRE-FIGHTING MEASURES
Water. Cool containers with flooding quantities of water until well after fire is out.
Do not use carbon dioxide or other gas filled fire extinguishers; they will have little effect on
decomposing persulfate.
Decomposes under fire conditions to release oxygen that intensifies the fire.
Contact with combustible material may cause fire
Not sensitive.
Not sensitive.
As in any fire, wear self-contained breathing apparatus pressure-demand, MSHA/NIOSH
(approved or equivalent) and full protective gear.
6. ACCIDENTAL RELEASE MEASURES
Keep off any unprotected persons. Avoid contact with the skin and the eyes. Avoid
breathing dust. Wear personal protective equipment.
Never add other substances or combustible waste to product residues.
Prevent material from entering into soil, ditches, sewers, waterways, and/or groundwater.
Page 3/ 9
Klozur® SP
Methods for Containment
Methods for cleaning up
Handling
Storage
Incompatible products
Control parameters
Exposure Guidelines
Chemical name
Sod ium Persulfate
7775-27-1
Chemical name
Sodium Persulfate
7775-27-1
SDS #: 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
See Section 12, Ecological Information for more detailed information.
Vacuum, shovel or pump waste into a drum and label contents for disposal. Avoid dust
formation. Store in closed container.
Clean up spill area and treat as special waste. Dispose of waste as indicated in Section 13 .
7. HANDLING AND STORAGE
Wear personal protective equipment Use only in area provided with appropriate exhaust
ventilation. Avoid dust formation . Handle product only in closed system or provide
appropriate exhaust ventilation at machinery. Avoid contact with skin and eyes. Avoid
breathing dust Remove and wash contaminated clothing before re-use . Reference to other
sections.
Keep containers tightly closed in a dry, cool and well-ventilated place. Keep away from
heat Do not store near combustible materials. Avoid contamination of opened product.
Keep away from food, drink and animal feedingstuffs . Avoid formation and deposition of
dust.
Acids, Alkalis, Hal ides, Combustible materials, Organ ic material, Reducing agents. Acids,
alkalis , halides (fluorides , chlorides , bromides), combustible materials, reducing agents and
organic compounds .
8. EXPOSURE CONTROLS/PERSONAL PROTECTION
ACGIH TLV OSHA PEL NIOSH Mexico
TWA: 0 .1 mg/m 3 ---
British Columbia Quebec Ontario TWAEV Alberta
TWA: 0.1 mg/m 3 -TWA: 0 .1 mg/m 3 TWA: 0.1 mg/m3
Appropriate engineering controls
Engineering measures Provide local exhaust or general ventilation adequate to maintain exposures below
permissable exposure lim its .
Individual protection measures , such as personal protective eq ui pment
Eye/Face Protection
Skin and Body Protection
Hand Protection
Respiratory Protection
Hygiene measures
General information
Eye protection recommended . Chemical goggles consistent with EN 166 or equivalent
Wear long-sleeved sh irt , long pants, socks, and shoes .
Protective gloves: Neoprene gloves, Polyvinylchloride, Natural Rubber.
If exposure limits are exceeded or irritation is experienced, NIOSH/MSHA approved
respiratory protection should be worn: particulate filtering facepiece respirators.
Keep away from food, drink and animal feeding stuffs. Do not eat, drink or smoke when
using this product Wash hands before breaks and after shifts. Keep work clothes separate ,
remove contaminated clothing -launder after open handling of product .
Protective engineering solutions should be implemented and in use before personal
protective equipment is considered .
9. PHYSICAL AND CHEMICAL PROPERTIES
Page 4/ 9
.J
Klozur® SP
SDS #: 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
Information on basic physical and chemical properties
Appearance
Physical State
Color
Odor
Odor threshold
pH
Melting poinUfreezing point
Boiling PoinURange
Flash point
Evaporation Rate
Flammability (solid, gas)
Flammability Limit in Air
Upper flammability limit:
Lower flammability limit:
Vapor pressure
Vapor density
Density
Specific gravity
Water solubility
Solubility in other solvents
Partition coefficient
Autoignition temperature
Decomposition temperature
Viscosity, kinematic
Viscosity, dynamic
Explosive properties
Oxidizing properties
Molecular weight
voe content (%)
Bulk density
Reactivity
Chemical Stability
Crystalline solid
Solid
White
odorless
Not applicable
6.0 (1% solution)
180 °C (Decomposes)
Decomposes upon heating
Not flammable
No information available
Not flammable
Not applicable
No information available
No information available
6.07E-30 mm Hg at 25°C
No information available
2.59 g/cm• (crystal density)
No information available
42 %@25 °C
No information available
No information available (inorganic)
No evidence of combustion up to 600°C No evidence of combustion up to 600 °C
> 100 °C (assume)
No information available (Solid)
No information available
Not explosive
oxidizer
238.1
Not applicable
1.12 g/cm• (loose)
10. STABILITY AND REACTIVITY
None under normal use condtions. Oxidizer. Contact with other material may cause fire
Stable.
Possibility of Hazardous Reactions None under normal processing.
Hazardous polymerization
Conditions to avoid
Incompatible materials
Hazardous polymerization does not occur.
Heat. Moisture.
Acids, alkalis, halides (fluorides, chlorides, bromides), combustible materials, reducing
agents and organic compounds .. Acids, Alkalis, Halides, Combustible materials, Organic
material, Reducing agents.
Hazardous Decomposition Products Oxygen which supports combustion
Product Information
Unknown acute toxicity
LD50 Oral
LD50 Dermal
LC50 Inhalation
Serious eye damage/eye irritation
Skin corrosion/irritation
11. TOXICOLOGICAL INFORMATION
0% of the mixture consists of ingredient(s) of unknown toxicity
Sodium Persulfate: 895 mg/kg (rat)
Sodium Persulfate: > 10 g/kg
Sodium Persulfate: >5.10 mg/L (4h) (rat)
Irritating to eyes.
Minimally irritating.
Page 5 / 9
Klozur:7 SP
Sensitization
Component Information
SDS # : 7775-27-1-12
Revision date: 2018-07-1 3
Version 1,04
Sodium Persulfate;, May cause sensitization by inhalation and skin contact.
Chemical name
LDSO Ora!
LD50 Dermal
LC50 Inhalation
NOAEL Oral Value
Sodium Persulfate
i7775-27-1t
895 mg/kg ( Rat)
7 10000 mg/kg ( Rabbit)
> 21.6 mg/L ( Rat) 4 h
Sodium sulfate
(7757-82-6)
> 10000 mg/kg ( Rat )
Information ontoxicological effects
Symptoms
Symptoms of allergic reaction may include rash, itching, swelling and trouble breathing.
Delayed and immediate effects as well as chronic effects from short and Tong -term exposure
Irritation
corrosivity
Carcinogenicity
Mutagenicity
Neurological effects
Reproductive toxicity
Developmental toxicity
Teratogenicity
STOT - single exposure
STOT - repeated exposure
Target organ effects
Aspiration hazard
Irritating to eyes, respiratory system and skin.
None.
Contains no ingredient listed as a carcinogen.
Did not show mutagenic effects in anima; experiments
Not neurotoxic
This product is not recognized as reprotox by Research Agencies.
None known.
Not teratogenic in animal studies_
May cause respiratory irritation.
Not classified.
Eyes, Lungs.
No information available.
12. ECOLOGICAL INFORMATION
Ecotoxicity
Ecotoxicity effects
Sodium Persulfate j7775-27 1),
Active Ingredientls)
Duration
Species
Vane
Units
Sodium Persulfate
96 h LC50
Rainbow trout
163
mg/L
Sodium Persulfate
48 h LC50
Daphnia magna
133
mg/L
Sodium Persulfate
96 h LC50
Grass shrimp
519
mg/L
Sodium Persulfate
72 h EC50
;Algae Selenastrum
caprlcomutum
116
mg/L
Persistence and degradability
Bloaccumulation
Mobility
Other Adverse Effects
Biodegradability does not pertain to inorganic substances.
Does not bioaccumulate.
Dissociates into ions.
None known.
Page 6 ! 9

Klozur® SP
Waste disposal methods
Contaminated Packaging
DOT
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
TDG
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
MEX
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
ICAO
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
ICAO/IATA
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
IMDG/IMO
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
ADR/RID
UN/ID no
Proper Shipping Name
Hazard class
Packing Group
ADN
Proper Shipping Name
Hazard class
Packing Group
U.S. Federal Re g ulations
13. DISPOSAL CONSIDERATIONS
SDS #: 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
This material, as supplied , is a hazardous waste according to federal regulations (40 CFR
261). It must undergo special treatment, e.g. at suitable disposal site, to comply with local
regulations.
Empty remaining contents. Dispose of in accordance with local regulations.
14. TRANSPORT INFORMATION
UN 1505
SODIUM PERSULFATE
5.1
Ill
UN 1505
SODIUM PERSULFATE
5.1
Ill
UN 1505
SODIUM PERSULFATE
5.1
Ill
UN 1505
SODIUM PERSULFATE
5 .1
Ill
UN 1505
SODIUM PERSULFATE
5.1
Ill
UN 1505
SODIUM PERSULFATE
5 .1
Ill
UN 1505
SODIUM PERSULFATE
5 .1
Ill
SODIUM PERSULFATE
5.1
Ill
15. REGULA TORY INFORMATION
Page 7 / 9
KIozurri) SP
SDS # : 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
SARA 313
Section 313 of Title Ili of the Superfund Amendments and Reauthorization Act of 1988 (SARA). This product does not contain any
chemicals which are subject to the reporting requirements of the Act and Title 40 of the Code of Federal Regulations, Part 372
SARA 311/312 Hazard Categories
This product is not subject to reporting under the Emergency Planning and Community Right -to -Know rule.
Clean Water Act
This product does not contain any substances regulated as pollutants pursuant to the Clean Water Act (40 CFR 122.21 and 40
CFR 122,42)
CERCLAIEPCRA
This material, as supplied, does not contain any substances regulated as hazardous substances under the Comprehensive
Environmental Response Compensation and Liability Act (CERCLA) (40 CFR 302) or the Superfund Amendments and
Reauthorization Act (SARA) (40 CFR 355). There may be specific reporting requirements at the local, regional, or state level
pertaining to releases of this material
US State Regulations
U.S. State Right -to -Know Regulations
This product contains the following substances regulated under state Right -to -Know laws:
Fchemical name
Massachusetts
New Jersey
Pennsylvania
Illinois
Rhode Island
Sodium Personate
x
Sodium sulfate
X
x
California Proposition 65
This product does not contain any Proposition 65 chemicals
CANADA
Environmental Emergencies
This product contains no substances listed under Canada's Environmental Emergency regulations.
Canadian National Pollutant Release Inventory
This product contains no substances reportable under Canada's National Pollutant Release Inventory regulations.
International Inventories
Component
TSCA
(United
States)
DSL
(Canada)
EINECSIEL.
INCS
(Europe)
ENCS
(Japan)
China
(IECSC)
KECL
(Korea)
PICCS
(Philippines
1
AICS
(Australia)
WZIoC
(New
Zealand)
Sodium Persulfate
7775-27-1 S > 99 1
X
X
X
X
X
X
X
X
x
Sodium sulfate
7757-82-6 < < 2 i
X
X
X
X
X
X
X
X
X
Mexico
Mexico - Grade
Slight risk, Grade i
16. OTHER INFORMATION
NFPA illeatth Hazards 1
Flammability 0
Stability 1
Special Hazards OX
HMIS Health Hazards 1
Flammability 0
Physical hazard 1
Special precautions J
NFPA/HMIS Ratings Legend
Special Hazards: OX = Oxidizer
Protection=J (Safety gaggles, gloves. apron, combination dust and vapor respirator)
Page 819

..
Klozur® SP
Revision date:
Revision note
Issuing Date:
Disclaimer
2018-07-13
SDS sections updated: 3
2017-03-17
SDS #: 7775-27-1-12
Revision date: 2018-07-13
Version 1.04
PeroxyChem believes that the information and recommendations contained herein (including data and statements) are
accurate as of the date hereof. NO WARRANTY OF FITNESS FOR ANY PARTICULAR PURPOSE, WARRANTY OF
MERCHANTABILITY OR ANY OTHER WARRANTY, EXPRESSED OR IMPLIED, IS MADE CONCERNING THE INFORMATION
PROVIDED HEREIN. The information provided herein relates only to the specified product designated and may not be
applicable where such product is used in combination with any other materials or in any process. Further, since the
conditions and methods of use are beyond the control of PeroxyChem, PeroxyChem expressly disclaims any and all
liability as to any results obtained or arising from any use of the products or reliance on such information.
Prepared By:
PeroxyChem
KLOZUR -Trademark of Peroxychem
© 2018 PeroxyChem. All Rights Reserved.
End of Safety Data Sheet
Page 9 / 9
OC)TI)C
Ma terial Safety Data Sheet
Sodium Hydroxide Solution
MSDS Number 26500TDC Reviewed: 09/12/2010
Section 1: CHEMICAL PRODUCT and COMPANY IDENTIFICATION
1.1 Product Name ....................................... Sodium Hydroxide solution
Chemical Family .................................... Inorganic salt solution
Synonyms .............................................. Sodium hydroxide, caustic, caustic soda
Formula .................................................. NaOH
1.2 Manufacturer ......................................... TDC, LLC
1.3
!Section
1916 Farmerville Highway
Ruston, Louisiana 71270
Information ............................................ [phone]
Emergency Contact ..................... . [phone]
[phone] (CHEMTREC)
2: COMPOSITION, INFORMATION ON INGREDIENTS
2.1 Chemical Ingredients(% by wt.)
!Section
NFPA:
Sodium hydroxide
Sodium Carbonate
Sodium Chloride
Water
CAS #: 1310-73-2
CAS #: 497-19-8
CAS #: 7647-14-5
CAS #:7732-18-5
(See Section 8 for exposure guidelines)
3: HAZARDS IDENTIFICATION
Health -3 Flammability - 0
Typical Analysis
49-51%
<0.2%
<1.0%
Balance
Reactivity -2
6 Pa es
2
j section 3: HAZARDS IDENTIFICATION (Cont.)
EMERGENCY OVERVIEW
Warning: Solution is highly alkaline
Contact will cause marked eye irritation and possible corneal damage.
Skin contact will result in irritation and possible corrosion of the skin.
Ingestion will irritate/burn mouth, throat and gastrointestinal tract.
3.1 POTENTIAL HEAL TH EFFECTS
EYE: Contact with the eyes will cause marked eye irritation and possibly severe corneal damage.
SKIN CONTACT: Contact with the skin will cause skin irritation or burning sensation. Prolonged contact will
result in corrosion of the skin.
SKIN ABSORPTION: Absorption is unlikely to occur.
INGESTION: Ingestion will result in severe burning and corrosion of mouth, throat and the gastrointestinal tract.
INHALATION: Breathing product mist or spray may cause damage to the upper respiratory tract and lung tissue
which could develop into chemical pneumonia depending upon severity of exposure.
CHRONIC EFFECTS/CARCINOGENICITY: Not listed as a carcinogen by NTP, IARC or OSHA.
!Section 4: FIRST AID MEASURES
4.1 EYES: Immediately flush with large quantities of water for 15 minutes. Hold eyelids apart during irrigation to
insure thorough flushing of the entire area of the eye. Obtain immediate medical attention.
4.2 SKIN: Immediately flush with large quantities of water. Remove contaminated clothing under a safety
shower. Obtain immediate medical attention
4.3 INGESTION: DO NOT INDUCE VOMITING. If victim is conscious, immediately give 2 to 4 glasses of water.
If vomiting does occur, repeat fluid administration. Obtain immediate medical attention.
4.4 INHALATION: Remove victim from contaminated atmosphere. If breathing is labored, administer oxygen. If
breathing has ceased, clear airway and start mouth to mouth resuscitation. If heart has stopped beating,
external heart massage should be applied. Obtain immediate medical attention.
!section 5: FIRE FIGHTING MEASURES
5.1 FLAMMABLE PROPERTIES
FLASH POINT: Not flammable
5.2 FLAMMABLE LIMITS NA
METHOD USED: NA
5.3 EXTINGUISHING MEDIA: Water spray or foam or as appropriate for combustibles involved in fire.
5.4 FIRE & EXPLOSIVE HAZARDS: Solution is non-flammable. Keep containers/storage vessels in fire area
cooled with water spray.
3
!Section 5: FIRE FIGHTING MEASURES, Cont.
5.5 FIRE FIGHTING EQUIPMENT: Wear self-contained breathing apparatus, positive pressure, MSHA/NIOSH
(approved or equivalent) and full protective gear.
!Section 6: ACCIDENTAL RELEASE MEASURES
6.1 Small releases: Confine and absorb small releases on sand earth or other inert absorbent. Neutralize
solution with weak (~5%) acetic acid if necessary. DO NOT NEUTRALIZE WITH STRONG MINERAL ACIDS,
THIS WILL EVOLVE LARGE AMOUNTS OF HEAT.
6.2 Large releases: Wear proper protective equipment. Confine area to qualified personnel. Shut off release if
safe to do so. Dike spill area to prevent runoff into sewers , drains or surface waterways (potential aquatic
toxicity). Recover as much of the solution as possible. Treat remaining material as a small release (above). DO
NOT NEUTRALIZE WITH STRONG MINERAL ACIDS, THIS WILL EVOLVE LARGE AMOUNTS OF HEAT.
!Section 7: HANDLING and STORAGE
7.1 Handling: Wear proper protective equipment (See Section 8). Avoid breathing product mist or spray. Avoid
contact with skin and eyes. Use only in a well ventilated area . Dilute product only in enclosed containers. Wash
thoroughly after handling.
7.2 Storage: Store in well ventilated areas. Do not store combustibles in the area of storage vessels . Keep
away from any sources of heat or flame. Store tote and smaller containers out of direct sunlight at moderate
temperatures [<80° F (27° C)]. (See Section 10.4 for materials of construction)
!Section 8: EXPOSURE CONTROLS, PERSONAL PROTECTION
8.1 RES Pl RA TORY PROTECTION: If working near open container or storage vessel opening or open tank
truck dome cover, wear self-contained breathing apparatus, positive pressure, MSHA/NIOSH (approved or
equivalent).
8.2 SKIN PROTECTION: Neoprene rubber gloves, chemical suit and boots should be worn to prevent contact
with the liquid. Wash contaminated clothing prior to reuse . Contaminated leather shoes cannot be cleaned and
should be discarded .
8.3 EYE PROTECTION: Chemical goggles and a full face shield.
8.4 EXPOSURE GUIDELINES:
OSHA ACGIH
TWA STEL TLV STEL
2ppm 2 ppm (ceiling)
8.5 ENGINEERING CONTROLS: Use adequate exhaust ventilation to prevent inhalation of product vapors.
Where feasible scrub process or storage vessel vapors with caustic solution. Maintain eyewash/safety shower in
areas where chemical is handled .
4
!Section 9: PHYSICAL and CHEMICAL PROPERTIES
9.1 APPEARANCE:
9.2 ODOR:
9.3 BOILING POINT:
9.4 VAPOR PRESSURE:
9.5 VAPOR DENSITY: (Air= 1.0)
9.6 SOLUBILITY IN WATER:
9.7 SPECIFIC GRAVITY:
9.8 FREEZING POINT:
9.9 pH:
9.10 VOLATILE:
Colorless to slightly hazy liquid.
No distinct odor.
293°F (145°C)
1.5 mm Hg, (0.2 Pa) @ 20°c
Not applicable
Complete
1.52 (12.66 lbs/gal)@ 20°C
Approximately 58°F (14°C)
14.0
Not determined
!Section 10: STABILITY and REACTIVITY
10.1 STABILITY: This is a stable material
10.2 HAZARDOUS POLYMERIZATION: Will not occur.
10.3 HAZARDOUS DECOMPOSITION PRODUCTS: None
10.4 INCOMPATIBILITY: Acids will cause the release of heat. Sodium hydroxide solution is not com patible with
zinc, aluminum or their alloys (i.e. galvanized metals, etc.). These materials of construction should not be used
in handling systems or storage containers for this product. (SEE Section 7.2, Storage)
!section 11: TOXICOLOGICAL INFORMATION
11.1 ORAL: Data not available
11.2 DERMAL: LD 50: 1350 mg/kg (rabbit)
11.3 INHALATION: Not available
11.4 CHRONIC/CARCINOGENICITY: No evidence available
11.5 TERATOLOGY: Data not available
11.6 REPRODUCTION: Data not available
11.7 MUTAGENICITY: Data not available
!Section 12: ECOLOGICAL INFORMATION
None available
5
!Section 13: DISPOSAL CONSIDERATIONS
If released to the environment for other than its intended purpose, this product pH will be high enough to meet
the definition of a corrosive waste, D002. DO NOT ALLOW into any sewers, on the ground , or into any body of
water.
!Section 14: TRANSPORT INFORMATION
14.1 DOT Shipping Name:
14.2 DOT Hazard Class:
14.3 UN/NA Number:
14.4 Packing Group:
14.5 DOT Placard:
14.6 DOT Label(s):
14.7 IMO Shipping Name:
14.8 RQ (Reportable Quantity):
14.9 RR STCC Number:
Sodium hydroxide solution
8
UN1824
II
Corrosive
Corrosive
Sodium hydroxide solution
1,000 lbs (454 Kg) 100% basis
!Section 15: REGULA TORY INFORMATION
15.1 OSHA: This product is listed as a hazardous material under criteria of the Federal
OSHA Hazard Communication Standard, 29 CFR 1910.1200.
15.2 SARA TITLE Ill: a .
b.
EHS (Extremely Hazardous Substance) List:
Section 311/312, (Tier 1,11) Categories: Immediate (acute)
Fire
Sudden release
Reactivity
Delayed (chronic)
c . Section 313 (Toxic Release Report-Form R):
d. TPQ (Threshold Planning Quantity):
15.3 CERCLA/SUPERFUND: RQ (Reportable Quantity)
15.4 TSCA (Toxic Substance Control Act) Inventory List:
15.5 RCRA (Resource Conservation and Recovery Act) Status:
15.6 WHMIS (Canada) Hazard Classification :
15.7 DOT Hazardous Material : (See Section 14)
15.8 CAA Hazardous Air Pollutant (HAP)
No
Yes
No
No
Yes
No
No
No
1,000 lbs
(454 Kg)
Yes
Yes (See
Section 13)
E
Yes
No
6
]Section 16: OTHER INFORMATION
REVISIONS: The MSDS was formatted to comply with ANSI Standard 2400.1-2004
Revised Logo and Emergency Telephone Number, 02/23/2007.
Reviewed 9/12/10.
THE INFORMATION PUBLISHED IN THIS MATERIAL SAFETY DATA SHEET HAS BEEN COMPILED FROM OUR EXPERIENCE AND
OSHA, ANSI, NFPA, DOT, ERG, AND CHRIS. IT IS THE USER'S RESPONSIBILITY TO DETERMINE THE SUITABILITY OF THIS
INFORMATION FOR THE ADOPTION OF NECESSARY SAFETY PRECAUTIONS. WE RESERVE THE RIGHT TO REVISE MATERIAL
SAFETY DATA SHEETS PERIODICALLY AS NEW INFORMATION BECOMES AVAILABLE.