WI0400583_Permit (Issuance)_20220330

North Carolina Department of Environmental Quality—Division of Water Resources
NOTIFICATION OF INTENT (NOI) TO CONSTRUCT OR OPERATE INJECTION WELLS
The following are "permitted by rule"and do not require an individual permit when constructed in accordance
with the rules of 15A NCAC 02C.0200(NOTE: This form must be received at least 14 DAYS 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.
Print Clearly or Type Information. Illegible Submittals Will Be Returned As Incomplete.
DATE: March 23 ,20_22 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: State Government
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): NCDEQ-DWM,UST Section,Federal& State Lead Program(TF#13934);Attn: Sharon Ghiold
Mailing Address: 1646 Mail Service Center
City: Raleigh State:NC Zip Code: 27699-1646 County: Wake
Day Tele No.: 919-707-8166 Cell No.: NA
EMAIL Address: sharon.ghiold@,ncdenr.gov Fax No.: 919-571-4718
Deemed Permitted GW Remediation NOI Rev. 1-06-2021 Page 1

D. PROPERTY OWNER(S)(if different than well owner/applicant)
Name and Title: Leslie Lee Linthicum
Company Name N/A
Mailing Address: 1628 Harrison Trail
City: Sophia State: NC Zip Code: 27350 County:Randolph
Day Tele No.: 336-953-1472 Cell No.:
EMAIL Address: [e-mail] Fax No.:
E. PROJECT CONTACT(Typically Environmental Engineering Firm)
Name and Title: Elizabeth A.Allyn,P.G.,Environmental Project Geologist II
Company Name WithersRavenel,Inc.
Mailing Address: 115 MacKenan Drive
City: Cary State: NC Zip Code:27511 County: Wake
Day Tele No.: 919-469-3340 Cell No.: 919-418-0279
EMAIL Address: [e-mail] Fax No.: 919-467-6008
F. PHYSICAL LOCATION OF WELL SITE
(1) Facility Name&Address: NCDOT Parcel 90; 5409 US Highway 311,NCDEQ Incident#13934
City: Sophia County: Randolph Zip Code: 27350
(2) Geographic Coordinates: Latitude**: 35.813124°
Longitude**: -79.838540°
Reference Datum: Google Earth Accuracy: +/- 5m
Method of Collection: Google Earth
**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: 7,560 square feet
Land surface area of inj.well network: —674 square feet(< 10,000 ft2 for small-scale injections)
Percent of contaminant plume area to be treated: 8.9% (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. 1-06-2021 Page 2

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: Elimination of GCL exceedances in groundwater at site
Scope: Characterization samples for injection calculations followed by injection of BOS 200 activated carbon
based in-situ remediation slurry into 27 injection points.
Goals: Significant reduction of source area contamination through removal of dissolved-phase petroleum
contamination with the aid of injections.
J. APPROVED INJECTANTS—Provide a MSDS for each injectant(attach additional sheets if necessary).
NOTE: Only injectants approved by the NC Division of Public Health, Department of Health and Human
Services can be injected. Approved 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: BOS 200
Volume of injectant: 5,800 lbs BOS 200 diluted in 2,573 gal water
Concentration at point of injection: —2.25 lb BOS 200/gal water
Percent if in a mixture with other injectants: 46.5%BOS 200
Inj ectant:
Volume of injectant:
Concentration at point of injection:
Percent if in a mixture with other injectants:
Inj ectant:
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: 27(injection points,not wells) Proposed 0 Existing(provide GW-Is)
(2) For Proposed wells or Existing wells not having GW-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):
Deemed Permitted GW Remediation NOI Rev. 1-06-2021 Page 3

L. SCHEDULES—Briefly describe the schedule for well construction and injection activities.
1) 27 injection points will be advanced for direct injection of BOS 200 slurry with additives.No injection wells
will be installed during this process.
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.
1) Post-injection sampling of monitoring wells MW-1,MW-5,MW-6,and MW-8 will be completed at the end
of the injection event.
2) Monitor site semi-annually until incident closed.
N. SIGNATURE OF APPLICANT AND PROPERTY OWNER
Well 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 on my inquiry of those individuals
immediately responsible for obtaining said information, I believe that the information is true, accurate and
complete. I am aware that there are significant penalties, including the possibility of fines and imprisonment,
for 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."
541
Elizabeth A.Allyn,PG,Environmental Project Geologist II,WithersRavenel
On behalf on NCDEQ-DWM,UST Section for Incident#13934
Signature of Applicant Print or Type Full Name and Title
Property Owner(if the property is not owned by the Well Owner/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.
SEE ATTACHED NCDEQ STATE -LEAD ACCESS AGREEMENT FOR PROPERTY
Signature*of Property Owner(if different from applicant) Print or Type Full Name and Title
*An access agreement between the applicant and property owner may be submitted in lieu of a signature on this form.
Please send 1 (one) hard color copy of his NOI along with a copy on an attached CD or Flash Drive at least
two(2)weeks prior to injection to:
DWR—UIC Program
1636 Mail Service Center
Raleigh,NC 27699-1636
Telephone: [phone]
Deemed Permitted GW Remediation NOI Rev. 1-06-2021 Page 4

WithersRavenel
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FIGURES
NCDOT Parcel 90 - NCDEQ Incident#13934 WR Project#02170214.77
Notice of Intent- UIC March 2022

._ 1 / • M
o1-
•
4
d No
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FORMER FORMER ` N
GAS STATION GASOLINE/KEROSENE 1 ii
ZCI
UST LOCATIONS QFli
1BUILDING
MW-7 W Us
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C 9 MW-8 0 p U 0 '�
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FORMER GASOLINE _ _
' UST LOCATIONS M,W-1 -
- _ SW-4
(1,320)
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LEGEND ,-
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® WATER SUPPLY WELL r •.4•, v
TYPE II MONITORING WELL LOCATION �f' •/. ' +', ,/T>u7
(NS) NOT SAMPLED *N f, 1/.'.,1 °J
(1,320) CONCENTRATION OF BENZENE IN UG/L � I, L•— , •
ESTIMATED AREA OF GROUNDWATER - _ v g
v
I BENZENE GCL EXCEEDANCES J.J .
w o
ESTIMATED AREA OF GROUNDWATER GRAPHI SCALE 3
BENZENE AT CONCENTRATIONS EXCEEDING 2L STANDARD bi 0 15 30 60 Y
NOTES: �. 11
``
AERIAL OBTAINED FROM THE RANDOLPH COUNTY GIS DEPARTMENT. 11041 ,,
DATA SHOWN FOR GROUNDWATER SAMPLES OBTAINED IN NOVEMBER & DECEMBER 2021 1 inch=30 ft.

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. I (79.95)
FORMER GASOLINE I I J
UST LOCATIONS (79.50)
MW1I - . _
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ei O% M
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GROUNDWATER ELEVATION CONTOUR
(DASHED WHERE INFERRED) rri .
(83.44) GROUNDWATER ELEVATION (FT) n/
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GROUNDWATER FLOW DIRECTION L"
NOTES: = z
v
1. 2013 AERIAL OBTAINED FROM THE RANDOLPH COUNTY GIS .LJ .5
1DEPARTMENT.
3 W o
GRAPHIC SCALE
0 15 30 60 ``
,,1 inch=30 ft.

WithersRavenel
Our People.Your Success.
DIAGRAM OF TYPICAL INJECTION POINT
NCDOT Parcel 90 - NCDEQ Incident#13934 WR Project#02170214.77
Notice of Intent - UIC March 2022

WithersRavenel
Engineers I Planners I Surveyors
TYPICAL INJECTION POINT-AREA A
Boring#TBD Job Name NCDOT Parcel 90(NCDEQ Inc. 13934) Job#02170214.77
Date TBD Site Loc. Sophia,Randolph County,NC Easting NA
WR Rep TBD Driller SAEDACCO Northing NA
Depth in Feet
(below land Detail
surface) Soil Description
From To (Field USCS Classification)
0 20
C
-o
a
c
0
0
-a)
C
F
a
0
Native Soils(TBD)
20 28 -0
c
> 3
o 0 m
0
• `C
U N
N N
DPT injection points extend to 28 feet below
land surface. Injection intervals for each point
are 20 to 28 feet below land surface. Following
completion of injections,each point will be
abandoned with bentonite and/or concrete to
match original surface grade.
Page 1 of 1
115 MacKenan Drive,Cary,North Carolina 27511 te1:919.469.3340 fax:[phone] www.withersravenel.com

;! WithersRavenel
Engineers I Planners I Surveyors
TYPICAL INJECTION POINT-AREA B
Boring#TBD Job Name NCDOT Parcel 90(NCDEQ Inc. 13934) Job#02170214.77
Date TBD Site Loc. Sophia,Randolph County,NC Easting NA
WR Rep TBD Driller SAEDACCO Northing NA
Depth in Feet
(below land Detail
surface) Soil Description
From To (Field USCS Classification)
0 15
C
-o
a
c
0
0
a)
C
1—
Native Soils(TBD) _
15 30
0
0
Co
_
N i
c 3
C o
o o
U
N N
•C
M
u7
DPT injection points extend to 30 feet below
land surface. Injection intervals for each point
are 15 to 30 feet below land surface. Following
completion of injections,each point will be
abandoned with bentonite and/or concrete to
match original surface grade.
Page 1 of 1
115 MacKenan Drive,Cory,North Carolina 27511 te1:919.469.3340 fax:[phone] www.withersravenel.com

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BOSS 200 SAFETY DATA SHEET
NCDOT Parcel 90 - NCDEQ Incident#13934 WR Project#02170214.77
Notice of Intent - UIC March 2022

TRAP & TREAT® BOS 200®
Safety Data Sheet
CalgonCarborr
Issued:06/05/2015
Supersedes:12/30/2011
Version:1.0
.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
SECTION 1: Identification of the Substance/Mixture and of the Company/Undertaking
1.1. Product identifier
Product name : Activated Carbon
Product form : Mixture
Product code : 3967
Other means of identification : Activated Carbon
1.2. Relevant identified uses of the substance or mixture and uses advised against
Use of the substance/mixture : Adsorbent
1.3. Details of the supplier of the safety data sheet
Calgon Carbon Corporation
P.O. Box 717
Pittsburgh, PA 15230
412-787-6700
1.4. Emergency telephone number
Emergency number : CHEMTREC(24 HRS): 1-800-424-9300
SECTION 2: Hazards Identification
2.1. Classification of the substance or mixture
GHS-US classification
Combustible Dust H232
Not classified as a simple asphyxiant. Product does not displace oxygen in the ambient atmosphere, but slowly adsorbs oxygen from a confined
space when wet. Under conditions of anticipated and recommended use,product does not pose an asphyxiation hazard.
2.2. Label elements
GHS-US labeling
Signal word(GHS-US) : Warning
Hazard statements(GHS-US) : H232-May form combustible dust concentrations in air
2.3. Other hazards
Other hazards not contributing to the : Wet activated carbon can deplete oxygen from air in enclosed spaces. If use in an enclosed
classification space is required, procedures for work in an oxygen deficient environment should be followed.
2.4. Unknown acute toxicity(GHS-US)
No data available
SECTION 3: Composition/Information on Ingredients
3.1. Substance
Not applicable
3.2. Mixture
Name Product identifier
Activated Carbon (CAS No)7440-44-0 >_80
Gypsum(Hydrated calcium sulfate) (CAS No)13397-24-5 <20
SECTION 4: First Aid Measures
4.1. Description of first aid measures
First-aid measures general : If exposed or concerned,get medical attention/advice.Show this safety data sheet to the
doctor in attendance.Wash contaminated clothing before re-use. Never give anything to an
unconscious person.
First-aid measures after inhalation : IF INHALED: Remove to fresh air and keep at rest in a position comfortable for breathing.
First-aid measures after skin contact : IF ON SKIN(or clothing): Remove affected clothing and wash all exposed skin with water for at
least 15 minutes.
First-aid measures after eye contact : IF IN EYES: Immediately flush with plenty of water for at least 15 minutes.Remove contact
lenses if present and easy to do so. Continue rinsing.
First-aid measures after ingestion : IF SWALLOWED:Rinse mouth thoroughly. Do not induce vomiting without advice from poison
control center or medical professional. Get medical attention if you feel unwell.
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3967

Activated Carbon
Safety Data Sheet
4.2. Most important symptoms and effects, both acute and delayed
Symptoms/injuries : Not expected to present a significant hazard under anticipated conditions of normal use.
However,dust may cause irritation and redness of the eyes,irritation of the skin and respiratory
system.The effects of long-term,low-level exposures to this product have not been
determined.
4.3. Indication of any immediate medical attention and special treatment needed
No additional information available
SECTION 5: Firefighting Measures
5.1. Extinguishing media
Suitable extinguishing media : Water spray.Carbon dioxide. Dry chemical. Foam.Sand.
Unsuitable extinguishing media : None known.
5.2. Special hazards arising from the substance or mixture
Fire hazard : Dust may be combustible under specific conditions. May be ignited by heat,sparks or flames.
Explosion hazard : Dust may form explosive mixture in air.
Reactivity : No dangerous reactions known under normal conditions of use. Carbon oxides, ammonia,or
toxic halide fumes may be emitted upon combustion of the material.
5.3. Advice for firefighters
Firefighting instructions : Wear NIOSH-approved self-contained breathing apparatus suitable for the surrounding fire.
Use water spray or fog for cooling exposed containers. Evacuate area.
SECTION 6: Accidental Release Measures
6.1. Personal precautions,protective equipment and emergency procedures
General measures : Evacuate area.Keep upwind.Ventilate area.Spill should be handled by trained clean-up crews
properly equipped with respiratory equipment and full chemical protective gear(see Section 8).
6.1.1. For non-emergency personnel
No additional information available
6.1.2. For emergency responders
No additional information available
6.2. Environmental precautions
Prevent entry to sewers and public waters.Avoid release to the environment. Product is not soluble,but can cause particulate emission of
discharged into waterways. Dike all entrances to sewers and drains to avoid introducing material to waterways. Notify authorities if product enters
sewers or public waters.
6.3. Methods and material for containment and cleaning up
For containment : Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Methods for cleaning up : Sweep or shovel spills into appropriate container for disposal. Minimize generation of dust.
Dispose of material in compliance with local,state,and federal regulations.
6.4. Reference to other sections
No additional information available
SECTION 7: Handling and Storage
7.1. Precautions for safe handling
Precautions for safe handling : Avoid dust formation.Avoid contact with skin,eyes and clothing.Do not handle until all safety
precautions have been read and understood.Wash hands and other exposed areas with mild
soap and water before eating,drinking or smoking and when leaving work. Keep away from
sources of ignition-No smoking.
7.2. Conditions for safe storage, including any incompatibilities
Storage conditions : Keep container tightly closed in a cool,dry,and well-ventilated place. Keep away from ignition
sources.
SECTION 8: Exposure Controls/Personal Protection
8.1. Control parameters
Activated Carbon(7440-44-0)*
OSHA PEL(TWA)(mg/m3) <_5(Respirable Fraction)
<_15(Total Dust)
R
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Activated Carbon
Safety Data Sheet
Gypsum(Hydrated calcium sulfate)(13397-24-5)*
OSHA PEL(TWA)(mg/m3) <_5(Respirable Fraction)
<_15(Total Dust)
*Exposure limits are for inert or nuisance dust. No specific exposure limits have been established for this activated carbon product by OSHA or ACGIH.
8.2. Exposure controls
Appropriate engineering controls : Provide adequate general and local exhaust ventilation. Use process enclosures,local exhaust
ventilation,or other engineering controls to control airborne levels below recommended
exposure limits. Use explosion-proof equipment with flammable materials.Ensure adequate
ventilation,especially in confined areas.Wet activated carbon can deplete oxygen from air in
enclosed spaces. If use in an enclosed space is required, procedures for work in an oxygen
deficient environment should be followed.
Personal protective equipment : Gloves.Safety glasses. Insufficient ventilation:wear respiratory protection.
lO'OI 1111
Hand protection : Gloves should be classified under Standard EN 374 or ASTM F1296.Suggested glove
materials are: Neoprene, Nitrile/butadiene rubber, Polyethylene, Ethyl vinyl alcohol laminate,
PVC or vinyl.Suitable gloves for this specific application can be recommended by the glove
supplier.
Eye protection : Use eye protection suitable to the environment.Avoid direct contact with eyes.
Skin and body protection : Wear long sleeves,and chemically impervious PPE/coveralls to minimize bodily exposure.
Respiratory protection : Use NIOSH-approved dust/particulate respirator.Where vapor,mist,or dust exceed PELs or
other applicable OELs,use NIOSH-approved respiratory protective equipment.
SECTION 9: Physical and Chemical Properties
9.1. Information on basic physical and chemical properties
Physical state : Solid
Appearance : Granular, powder,or pelletized substance
Color : Black
Odor : Odorless
Odor threshold : No data available
pH : No data available
Relative evaporation rate(butylacetate=1) : Not applicable
Melting point : Not applicable
Freezing point : Not applicable
Boiling point : Not applicable
Flash point : No data available
Auto-ignition temperature : >220°C
Decomposition temperature : No data available
Flammability(solid,gas) : >220°C
Vapor pressure : Not applicable
Relative vapor density at 20°C : Not applicable
Apparent density : 0.4-0.8 g/cc
Solubility : Carbon and gypsum are insoluble;fertilizer components are soluble
Log Pow : Not applicable
Log Kow : Not applicable
Viscosity,kinematic : Not applicable
Viscosity,dynamic : Not applicable
Explosive properties : No data available
Oxidizing properties : No data available
Explosive limits : No data available
9.2. Other information
No additional information available
R
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Activated Carbon
Safety Data Sheet
SECTION 10: Stability and Reactivity
10.1. Reactivity
No dangerous reactions known under normal conditions of use.
10.2. Chemical stability
Stable under use and storage conditions as recommended in section 7.
10.3. Possibility of hazardous reactions
None known.
10.4. Conditions to avoid
Avoid dust formation. Heat. Ignition sources. Exposure to high concentrations of organic compounds may cause bed temperature to rise.
10.5. Incompatible materials
Alkali metals.Strong oxidizing agents.
10.6. Hazardous decomposition products
Carbon monoxide(CO),carbon dioxide(CO2).Ammonia.Toxic halide fumes.
SECTION 11: Toxicological Information
11.1. Information on toxicological effects
Acute toxicity : Not classified
Activated Carbon(7440-44-0)
LD50 oral rat >2000 mg/kg
Skin corrosion/irritation : Not classified
Serious eye damage/irritation : Not classified
Respiratory or skin sensitisation : Not classified
Germ cell mutagenicity : Not classified
Carcinogenicity : Not classified
Silica: Crystalline,quartz(14808-60-7)
IARC group 1 -Carcinogenic to humans
The International Agency for Research on Cancer(IARC)has classified "silica dust,crystalline,in the form of quartz or cristobalite"as carcinogenic
to humans(group 1).However these warnings refer to crystalline silica dusts and do not apply to solid activated carbon containing crystalline silica
as a naturally occuring,bound impurity.As such,we have not classified this product as a carcinogen in accordance with the US OSHA Hazard
Communication Standard(29 CFR§1910.1200)but recommmend that users avoid inhalation of product in a dust form.
Reproductive toxicity : Not classified
Specific target organ toxicity(single exposure) : Not classified
Specific target organ toxicity(repeated : Not classified
exposure)
Aspiration hazard : Not classified
Symptoms/injuries after inhalation : Not classified
Symptoms/injuries : Not expected to present a significant hazard under anticipated conditions of normal use.
However,dust may cause irritation and redness of the eyes,irritation of the skin and respiratory
system.The effects of long-term,low-level exposures to this product have not been
determined.
SECTION 12: Ecological information
12.1. Toxicity
No additional information available
12.2. Persistence and degradability
No additional information available
12.3. Bioaccumulative potential
No additional information available
12.4. Mobility in soil
No additional information available
12.5. Other adverse effects
No additional information available
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Activated Carbon
Safety Data Sheet
SECTION 13: Disposal Considerations
13.1. Waste treatment methods
Waste treatment and disposal methods : Vacuum or shovel material into a closed container.Dispose in a safe manner in accordance
with local/national regulations. Do not allow the product to be released into the environment.
Additional information : Activated carbon is an adsorbent media; hazard classification is generally determined by the
adsorbate.Consult U.S.EPA guidelines listed in 40 CFR 261.3 for more information on
hazardous waste disposal.
SECTION 14: Transport Information
14.1.In accordance with DOT
Not classified as hazardous for domestic land transport
UN-No.(DOT) : None on finished product
DOT NA no. : None on finished product
Proper Shipping Name(DOT) : Not regulated
Department of Transportation(DOT)Hazard : None on finished product
Classes
Hazard labels(DOT) : None on finished product
Packing group(DOT) : None on finished product
DOT Quantity Limitations Passenger aircraft/rail : None on finished product
(49 CFR 173.27)
14.2.Transport by sea
Not classified as hazardous for water transport
IMO/IMDG
UN/NA Identification Number : None on finished product
UN-Proper Shipping Name : Not regulated
Transport Hazard Class : None on finished product
14.3.Air transport
Not classified as hazardous for air transport
ICAO/IATA
UN/NA No : None on finished product
UN-Proper Shipping Name : Not regulated
Transport Hazard Class : None on finished product
Packing Group : None on finished product
Marine Pollutant : None on finished product
14.4.Additional information
Other information : Under the UN classification for activated carbon,all activated carbons have been identified as a
class 4.2 product. However,this product type or an equivalent has been tested according to
the United Nations Transport of Dangerous Goods test protocol for a"self-heating substance"
(United Nations Transportation of Dangerous Goods,Manual of Tests and Criteria,Part Ill,
Section 33.3.1.6-Test N.4-Test Method for Self Heating Substances)and it has been
specifically determined that this product type or an equivalent does not meet the definition of a
DOT self-heating substance(class 4.2)or any other hazard class.
SECTION 15: Regulatory Information
15.1.US Federal regulations
Activated Carbon Profile 85
All chemical substances in this product are listed in the EPA(Environment Protection Agency)TSCA(Toxic Substances Control Act)Inventory
or are exempt.
SARA Section 311/312 Hazard Classes Immediate(acute)health hazard
Cobalt(7440-48-4)*
Listed on the United States TSCA(Toxic Substances Control Act)inventory
Listed on United States SARA Section 313
SARA Section 313-Emission Reporting 0.1 °A°
*Present below de minimis level
15.2.International regulations
No additional information available
R
06/05/2015 TRAP&TREAT®BOS 2000 For Internal Use Only:PR#85 5/7
3967

Activated Carbon
Safety Data Sheet
15.3. US State regulations
California Proposition 65
WARNING:This product contains,or may contain,trace quantities of a substance(s)known to the state of California to cause cancer, birth defects,
or other reproductive harm.
Silica:Crystalline,quartz(14808-60-7)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Cobalt(7440-48-4)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Titanium dioxide(13463-67-7)
U.S.-California- U.S.-California- U.S.-California- U.S.-California- No significance risk level
Proposition 65- Proposition 65- Proposition 65- Proposition 65- (NSRL)
Carcinogens List Developmental Toxicity Reproductive Toxicity- Reproductive Toxicity-
Female Male
Yes No No No NA
Aluminum oxide(1344-28-1)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Massachusetts-Right to Know List
U.S.-Pennsylvania-RTK(Right to Know)-Environmental Hazard List
Calcium sulfate(7778-18-9)
U.S.-Massachusetts-Right to Know List
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know) List
Silica:Crystalline,quartz(14808-60-7)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know)List
U.S.-Massachusetts-Right to Know List
Gypsum(Hydrated calcium sulfate)(13397-24-5)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know)List
Ammonium Nitrate(6484-52-2)
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Massachusetts-Right To Know List
U.S.-Pennsylvania-RTK(Right to Know)List
Limestone(1317-65-3)
U.S.-Massachusetts-Right To Know List
U.S.-New Jersey-Right to Know Hazardous Substance List
U.S.-Pennsylvania-RTK(Right to Know)List
SECTION 16: Other Information
Indication of changes Revision 1.0: New SDS Created.
Revision Date 06/05/2015
Other information Author:CJS.
For internal use only PR#85
Prepared according to Federal Register/Vol.77,No.58/Monday,March 26,2012/Rules and Regulations
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Activated Carbon
Safety Data Sheet
NFPA health hazard : 0-Exposure under fire conditions would offer no hazard
beyond that of ordinary combustible materials.
NFPA fire hazard : 1 -Must be preheated before ignition can occur.
NFPA reactivity : 0-Normally stable,even under fire exposure conditions, 0 / 0
and are not reactive with water.
U
HMIS III Rating
Health : 0
Flammability : 1
Physical : 0
Personal Protection •
This information is based on our current knowledge and is intended to describe the product for the purposes of health, safety and environmental
requirements only. It should not therefore be construed as guaranteeing any specific property of the product. The information is this document
applies to this specific material as supplied. It may not be valid if product is used in combination with other materials. It is the user's responsibility to
determine the suitability and completeness of this information for their particular use.While the information and recommendations set forth herein
are believed to be accurate as of the date hereof,Calgon Carbon Corporation makes no warranty with respect to the same,and disclaims all liability
for reliance thereon.
06/05/2015 TRAP&TREAT®BOS 200® For Internal Use Only:PR#85 7/7
3967

WithersRavenel
Our People.Your Success.
AST ENVIRONMENTAL PROPOSAL
NCDOT Parcel 90 - NCDEQ Incident#13934 WR Project#02170214.77
Notice of Intent - UIC March 2022

Client Name NCDEQ
Project Location NCDOT Parcel 90,Sophia,NC
Area A Area B Totals
MW-6 MW-1
Site Information Predominate Geology of Treatment Zone
Treatment Zone Area(ft^2) 360 300 660
Contamination Depth Start(ft bgs) 20.0 15.0
Contamination Depth End(ft bgs) 28.0 30.0
Treatment Volume(yd^3) 106.7 166.7 273
Triangular Grid Spacing(ft) 5.0 5.0
Number of Injection Points-Design 15 12 27
Injection Interval Distance(ft) 1.5 1.5
Number of Injection Intervals per Point-Design 5.8 10.5
Total Number of Injection Intervals 88 126 214
Effective Porosity 30% 30%
Pore Volume(L) 24,468 38,232
Soil Density(Ib/f03) 110 110
Speciated COC Design Calculations Contaminant of Concern Benzene Benzene
Design Basis Soil(mg/kg)or Groundwater(mg/L) Groundwater Groundwater
Design Concentration 8.190 1.320
Design Endpoint 0.100 0.010
Contaminant of Concern Mass Loading(Ib/f03) 1.53E-04 2.47E-05
BOS 200 per Injection Interval-Design(Ib) 30 25
BOS 200 Slurry Volume per Interval(gal) 15 15
Average BOS 200 per Injection Point(Ib) 175 263
BOS 200 Total(Ib) 2,625 3,150 5,800
TPH Design Calculations TPH Groundwater Concentration(mg/L) 0 0
TPH Soil Concentration(mg/kg) 0 0
TPH Mass(Ib)
BOS 200 Total Demand(Ib) 0
Design Basis Select Speciated or TPH Speciated Speciated
Design BOS 200 Total per Area(Ib) 2,625 3,150 5,800
Trap&Treat Bacteria Calculations Bacteria Concentrate(gal) 5 6 15
Kinetic Design Additives Supplemental Gypsum per Interval-Design(Ib) 15 15 J
Total Supplemental Gypsum(Ib) 1,313 1,890 3,250
Supplemental Magnesium Sulfate per Interval-Design(Ib) 7.5 7.5
Total Supplemental Magnesium Sulfate(Ib) 656 945 1,650
Food Grade Starch per Interval(Ib) 7.5 7.5
Total Food Grade Starch(Ib) 656 945 1,650
Yeast Extract per Interval(Ib) 0.40 0.40 I
Total Yeast Extract(Ib) 35 50 110
Slurry and Water Volumes Slurry Volume per Interval(gal) 15 10 ,
Estimated Water Volume(gal) 1,313 1,260 2,573
1/14/2022

Client Name NCDEQ
Project Location NCDOT Parcel 90,Sophia,NC
Summary BOS 200 Total(Ib) 5,800
BOS 200 Unit Price($/lb,per RPI website) $6.00
Bacteria Concentrate(gal) 15
Bacteria Concentrate Price($/gal,per RPI website) $115
Supplemental Gypsum Total(Ib) 3,250
Gypsum Unit Price($/lb) $0.50
Magnesium Sulfate Total(Ib) 1,650
Magnesium Sulfate Unit Price($/lb) $0.65
Food Grade Starch Total(Ib) 1,650
Food Grade Starch Unit Price($/lb) $0.50
Yeast Extract Total(Ib) 110
Yeast Extract Unit Price($/lb) $10.00
Estimated Shipping and Tax($/lb) $0.35
Total Material Price($) $43,178
Number of Field Days to Complete 3
Injection Location Markout($)
Total Installation Price($) $16,822
Estimated RDC Price($)
Total Estimated Price($) $60,000
1/14/2022

ASSUMPTIONS
AST has made the following assumptions regarding this approach:
1. Pricing for products and services is valid for 180 days from the date of this proposal.
2. AST will support Withers Ravenel in preparing the UIC permit.
3. Pricing of the BOS 200° is based on the quantities outlined above. Should any of the
Proposed Injection Areas be removed from this design, pricing of the BOS 200° must be
adjusted to conform to the pricing structure shown at:
http://www.trapandtreat.com/products/quantity-pricinq/
4. There will be adequate water onsite (25-gpm service) to prepare the BOS materials for
injection. The water service within 200' of all injection locations and fire hoses can be
placed and remain in-place for the duration of the injection. Shuttling of water is not
required. The water will be provided at no cost to AST. Hydrant permits and fees will be
provided by others.
5. The site stratigraphy allows for pushing up to 250 linear feet of 2.25" Geoprobe® rods per
day and injection of up to 2,000 lbs. of BOS 200° per day.
6. Work is performed during standard work week and hours (Monday-Saturday 7am-6pm)
7. Asphalt/concrete penetrations will be patched with like materials.
8. All utilities and underground appurtenances will be located prior to AST arriving on site.
AST has not included any provisions to perform subsurface utility clearance (such as hand
auger boreholes or contracted utility location services). Hand augering and/or other
invasive utility clearances such as air knife will be performed at a minimum of 72-hours
prior to mobilization of AST Injection Staff and this service is not included or priced in this
proposal. This can be provided by AST for an additional cost. AST will not be responsible
for repairs to mis-marked or unmarked buried utilities and other appurtenances.
9. Investigated derived waste will be drummed and staged on site for disposal by others.
10. Boring logs will be prepared by others during the injection effort.
11. The total depth throughout the area identified in the injection design will be accessible via
direct push utilizing a Geoprobe° 7000 series rig.
12. Traffic control will be provided by others if required.
13. The project is non-union and will not require prevailing wages.
14. After hours security will be provided by others at no cost to AST, if deemed necessary.
15. PES will provide a dumpster for general refuse such as empty paper bags, pallets and other non-
hazardous waste.
16. Cold Weather Protocol
a. All injection work is to be performed with overnight temperatures above 32 degrees
F. If injections are to be performed with overnight lows below 32 degrees F, the
installation price will be subject to an additional 25% charge to account for loss
time for additional shutdown/startup time for the injection system.
b. Injection work in temperatures below 20 degrees F is a health and safety concern
for the injection crew. If temperatures are not above 20 degrees F by 10 a.m., no
injection work will be performed that day. A daily stand by rate will be charged for
days lost due to cold weather.
Payment terms are full payment of product and shipping costs upon arrival. Payment of injection
services is not to exceed 60 calendar days from date of invoice. Interest will accrue at a monthly
rate of 1.5% for all outstanding balances including interest. The interest rate will be prorated for
partial months.

WithersRavenel
Our People.Your Success.
ACCESS AGREEMENT
NCDOT Parcel 90 - NCDEQ Incident#13934 WR Project#02170214.77
Notice of Intent - UIC March 2022

Sharon Ghiold
DWM UST Section
1637 Mail Service Ctr
Raleigh, NC 27699- 1637
Dear Ms. Ghiold:
RE: Site Access Agreement
NCDOT Parcel 90 (Linthicum Property/TIP Parcel No. R-0839_90) •
4509 US Highway 311 (Hwy 311 S. and Old Courthouse Road)
Sophia, Randolph County, NC (WSRO)
STF # 13934, Risk: High H460D
I am/We are the owner(s) of a parcel of property, located at or near the incident in question,
and hereby permit the Department of Environment and Natural Resources (Department) or its
contractor to enter upon said property for the purpose of conducting an investigation of the
groundwaters under the authority of G.S . 143-215 . 3 (a)2.
I am/We are granting permission with the understanding that:
1 . The investigation shall be conducted by the UST Section of the Department's Division of Waste
Management or its contractor.
2. The costs of construction and maintenance of the she and access shall be borne by the
Department or its contractor. The Department or its contractor shall protect and prevent damage
to the surrounding lands.
3 . Unless otherwise agreed, the Department or its contractor shall have access to the site by the
shortest feasible route to the nearest public road. The Department or its contractor may enter
upon the land at reasonable times and have full right of access during the period of the
investigation.
4. Any claims which may arise against the Department or its contractor shall be governed by Article
31 of Chapter 143 of the North Carolina General Statutes, Tort Claims Against State
Departments and Agencies, and as otherwise provided by law.
5 . The information derived from the investigation shall be made available to the owner upon
request and is a public record, in accordance with G.S . 132-1 .
6. The activities to be carried out by the Department or its contractor are for the primary benefit
of the Department and of the State of North Carolina. Any benefits accruing to the owner are
incidental. The Department or its contractor is not and shall not be construed to be an agent,
employee, or contractor of the land owner.

NCDOT Parcel 90
STF # 13934
Page 2
I/We agree not to interfere with, remove, or any way damage the Department's well(s) or its
contractor's well(s) and equipment during the investigation.
cedjeL,
•
Signature Signature
Sherron L . Speaks Leslie Lee Linthicum
Type/Print Name of Owner or Agent Type/Print Name of Owner or Agent
3ity-) 13 - 19 5 (0 336 - 9s3 - / 4/ 7az
Phone Number Phone Number
03 QgKV , t4A) � c9 . /ZC?& /,2' ft Sow ram, /
Address Address
Po ; n1 ��. Ant, -)' sr Ain Not , 2 73sd
Sate Zip
Ci Code City/State/Zip ty/ t / p ty p Code
av - t3 � / 02.0 / .2
Date Date
PlIA;
Signature
Phyllis L . Sechrest
Type/Print Name of Owner or Agent
.53Y0 - e;r/- 702,
Phone Number
/64 i D L at
Address
e 4 . g . c27a63
City/State/Zip Code
r, 0Z6 . cr2-D /0
Date

HUGH C. BENNETT, JR.
Y Attorney at Law
� E iVC -�, ?s l { -';1 , High Point, North Carolina
T f `J S I r. ' ) i Telephone [phone]
Facsimile [phone]
OFFICE PM ,2; 0 ' MAILING ADDRESS
1506 Johnson Street 2013 �A� 30 I1 Post Office Box 660
High Point, NC 27262 High Point, NC 27261-0660
May 28, 2013
NCDENR
ATTN: Ms. Sharon Ghiold
1637 Mail Service Center
Raleigh, North Carolina 27699- 1646
Re: NCDOT Parcel 90 (Linthicum Property/TIP Parcel No. R-0839_90)
4509 US Highway 311 (Hwy. 311 S . and Old Courthouse Road)
Sophia, Randolph County, NC (WSRO)
STF # 13934, Risk: High H460D
Dear Ms. Ghiold:
I enclose with this letter the SITE ACCESS AGREEMENT, that you furnished to me
earlier in the month, which has been signed by the heirs.
Please furnish me with an acknowledgment of receipt of this document by e-mail to
[e-mail].
If I can be of further help to you in this matter please feel free to contact me.
Yours very truly, ,
►r
Hugh C. Bennett, Jr.
HCBjr: dws
Enclosure